hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|TX,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula."
"Val Verde Regional Medical Center",3/27/2026,3.0.0,"Val Verde Regional Medical Center","801 N Bedell Ave, Del Rio, TX 78840",,1891124640,,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|90_DEGREES_PLAN|MEDICARE|negotiated_dollar,standard_charge|90_DEGREES_PLAN|MEDICARE|negotiated_percentage,standard_charge|90_DEGREES_PLAN|MEDICARE|negotiated_algorithm,median_amount|90_DEGREES_PLAN|MEDICARE,10th_percentile|90_DEGREES_PLAN|MEDICARE,90th_percentile|90_DEGREES_PLAN|MEDICARE,count|90_DEGREES_PLAN|MEDICARE,standard_charge|90_DEGREES_PLAN|MEDICARE|methodology,additional_payer_notes|90_DEGREES_PLAN|MEDICARE,standard_charge|AETNA_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|AETNA_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|AETNA_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|AETNA_PLAN|COMMERCIAL,10th_percentile|AETNA_PLAN|COMMERCIAL,90th_percentile|AETNA_PLAN|COMMERCIAL,count|AETNA_PLAN|COMMERCIAL,standard_charge|AETNA_PLAN|COMMERCIAL|methodology,additional_payer_notes|AETNA_PLAN|COMMERCIAL,standard_charge|AETNA_CLINIC_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|AETNA_CLINIC_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|AETNA_CLINIC_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|AETNA_CLINIC_PLAN|COMMERCIAL,10th_percentile|AETNA_CLINIC_PLAN|COMMERCIAL,90th_percentile|AETNA_CLINIC_PLAN|COMMERCIAL,count|AETNA_CLINIC_PLAN|COMMERCIAL,standard_charge|AETNA_CLINIC_PLAN|COMMERCIAL|methodology,additional_payer_notes|AETNA_CLINIC_PLAN|COMMERCIAL,standard_charge|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL,10th_percentile|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL,90th_percentile|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL,count|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL,standard_charge|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL|methodology,additional_payer_notes|BCBC_OF_DEL_RIO_PLAN|COMMERCIAL,standard_charge|BCBS_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|BCBS_PLAN|COMMERCIAL,10th_percentile|BCBS_PLAN|COMMERCIAL,90th_percentile|BCBS_PLAN|COMMERCIAL,count|BCBS_PLAN|COMMERCIAL,standard_charge|BCBS_PLAN|COMMERCIAL|methodology,additional_payer_notes|BCBS_PLAN|COMMERCIAL,standard_charge|BCBS_MEDICARE_PLAN|MEDICARE|negotiated_dollar,standard_charge|BCBS_MEDICARE_PLAN|MEDICARE|negotiated_percentage,standard_charge|BCBS_MEDICARE_PLAN|MEDICARE|negotiated_algorithm,median_amount|BCBS_MEDICARE_PLAN|MEDICARE,10th_percentile|BCBS_MEDICARE_PLAN|MEDICARE,90th_percentile|BCBS_MEDICARE_PLAN|MEDICARE,count|BCBS_MEDICARE_PLAN|MEDICARE,standard_charge|BCBS_MEDICARE_PLAN|MEDICARE|methodology,additional_payer_notes|BCBS_MEDICARE_PLAN|MEDICARE,standard_charge|BCBS_PPO_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|BCBS_PPO_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|BCBS_PPO_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|BCBS_PPO_PLAN|COMMERCIAL,10th_percentile|BCBS_PPO_PLAN|COMMERCIAL,90th_percentile|BCBS_PPO_PLAN|COMMERCIAL,count|BCBS_PPO_PLAN|COMMERCIAL,standard_charge|BCBS_PPO_PLAN|COMMERCIAL|methodology,additional_payer_notes|BCBS_PPO_PLAN|COMMERCIAL,standard_charge|BLUE_ADV._HMO_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|BLUE_ADV._HMO_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|BLUE_ADV._HMO_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|BLUE_ADV._HMO_PLAN|COMMERCIAL,10th_percentile|BLUE_ADV._HMO_PLAN|COMMERCIAL,90th_percentile|BLUE_ADV._HMO_PLAN|COMMERCIAL,count|BLUE_ADV._HMO_PLAN|COMMERCIAL,standard_charge|BLUE_ADV._HMO_PLAN|COMMERCIAL|methodology,additional_payer_notes|BLUE_ADV._HMO_PLAN|COMMERCIAL,standard_charge|CIGNA_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|CIGNA_PLAN|COMMERCIAL,10th_percentile|CIGNA_PLAN|COMMERCIAL,90th_percentile|CIGNA_PLAN|COMMERCIAL,count|CIGNA_PLAN|COMMERCIAL,standard_charge|CIGNA_PLAN|COMMERCIAL|methodology,additional_payer_notes|CIGNA_PLAN|COMMERCIAL,standard_charge|FIRST_CARE_PLAN|MEDICAID|negotiated_dollar,standard_charge|FIRST_CARE_PLAN|MEDICAID|negotiated_percentage,standard_charge|FIRST_CARE_PLAN|MEDICAID|negotiated_algorithm,median_amount|FIRST_CARE_PLAN|MEDICAID,10th_percentile|FIRST_CARE_PLAN|MEDICAID,90th_percentile|FIRST_CARE_PLAN|MEDICAID,count|FIRST_CARE_PLAN|MEDICAID,standard_charge|FIRST_CARE_PLAN|MEDICAID|methodology,additional_payer_notes|FIRST_CARE_PLAN|MEDICAID,standard_charge|HUMANA_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|HUMANA_PLAN|COMMERCIAL,10th_percentile|HUMANA_PLAN|COMMERCIAL,90th_percentile|HUMANA_PLAN|COMMERCIAL,count|HUMANA_PLAN|COMMERCIAL,standard_charge|HUMANA_PLAN|COMMERCIAL|methodology,additional_payer_notes|HUMANA_PLAN|COMMERCIAL,standard_charge|HUMANA_MEDICARE_PLAN|MEDICARE|negotiated_dollar,standard_charge|HUMANA_MEDICARE_PLAN|MEDICARE|negotiated_percentage,standard_charge|HUMANA_MEDICARE_PLAN|MEDICARE|negotiated_algorithm,median_amount|HUMANA_MEDICARE_PLAN|MEDICARE,10th_percentile|HUMANA_MEDICARE_PLAN|MEDICARE,90th_percentile|HUMANA_MEDICARE_PLAN|MEDICARE,count|HUMANA_MEDICARE_PLAN|MEDICARE,standard_charge|HUMANA_MEDICARE_PLAN|MEDICARE|methodology,additional_payer_notes|HUMANA_MEDICARE_PLAN|MEDICARE,standard_charge|HUMANA_MILITARY_PLAN|MEDICARE|negotiated_dollar,standard_charge|HUMANA_MILITARY_PLAN|MEDICARE|negotiated_percentage,standard_charge|HUMANA_MILITARY_PLAN|MEDICARE|negotiated_algorithm,median_amount|HUMANA_MILITARY_PLAN|MEDICARE,10th_percentile|HUMANA_MILITARY_PLAN|MEDICARE,90th_percentile|HUMANA_MILITARY_PLAN|MEDICARE,count|HUMANA_MILITARY_PLAN|MEDICARE,standard_charge|HUMANA_MILITARY_PLAN|MEDICARE|methodology,additional_payer_notes|HUMANA_MILITARY_PLAN|MEDICARE,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_dollar,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_percentage,standard_charge|MEDICARE_PLAN|MEDICARE|negotiated_algorithm,median_amount|MEDICARE_PLAN|MEDICARE,10th_percentile|MEDICARE_PLAN|MEDICARE,90th_percentile|MEDICARE_PLAN|MEDICARE,count|MEDICARE_PLAN|MEDICARE,standard_charge|MEDICARE_PLAN|MEDICARE|methodology,additional_payer_notes|MEDICARE_PLAN|MEDICARE,standard_charge|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE|negotiated_dollar,standard_charge|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE|negotiated_percentage,standard_charge|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE|negotiated_algorithm,median_amount|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE,10th_percentile|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE,90th_percentile|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE,count|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE,standard_charge|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE|methodology,additional_payer_notes|SAN_FELIPE_DEL_RIO_PLAN|MEDICARE,standard_charge|TEXAS_MEDICAID_PLAN|MEDICAID|negotiated_dollar,standard_charge|TEXAS_MEDICAID_PLAN|MEDICAID|negotiated_percentage,standard_charge|TEXAS_MEDICAID_PLAN|MEDICAID|negotiated_algorithm,median_amount|TEXAS_MEDICAID_PLAN|MEDICAID,10th_percentile|TEXAS_MEDICAID_PLAN|MEDICAID,90th_percentile|TEXAS_MEDICAID_PLAN|MEDICAID,count|TEXAS_MEDICAID_PLAN|MEDICAID,standard_charge|TEXAS_MEDICAID_PLAN|MEDICAID|methodology,additional_payer_notes|TEXAS_MEDICAID_PLAN|MEDICAID,standard_charge|TML_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|TML_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|TML_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|TML_PLAN|COMMERCIAL,10th_percentile|TML_PLAN|COMMERCIAL,90th_percentile|TML_PLAN|COMMERCIAL,count|TML_PLAN|COMMERCIAL,standard_charge|TML_PLAN|COMMERCIAL|methodology,additional_payer_notes|TML_PLAN|COMMERCIAL,standard_charge|TRICARE_PLAN|MEDICARE|negotiated_dollar,standard_charge|TRICARE_PLAN|MEDICARE|negotiated_percentage,standard_charge|TRICARE_PLAN|MEDICARE|negotiated_algorithm,median_amount|TRICARE_PLAN|MEDICARE,10th_percentile|TRICARE_PLAN|MEDICARE,90th_percentile|TRICARE_PLAN|MEDICARE,count|TRICARE_PLAN|MEDICARE,standard_charge|TRICARE_PLAN|MEDICARE|methodology,additional_payer_notes|TRICARE_PLAN|MEDICARE,standard_charge|UHC_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|UHC_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|UHC_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|UHC_PLAN|COMMERCIAL,10th_percentile|UHC_PLAN|COMMERCIAL,90th_percentile|UHC_PLAN|COMMERCIAL,count|UHC_PLAN|COMMERCIAL,standard_charge|UHC_PLAN|COMMERCIAL|methodology,additional_payer_notes|UHC_PLAN|COMMERCIAL,standard_charge|UNICARE_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|UNICARE_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|UNICARE_PLAN|COMMERCIAL|negotiated_algorithm,median_amount|UNICARE_PLAN|COMMERCIAL,10th_percentile|UNICARE_PLAN|COMMERCIAL,90th_percentile|UNICARE_PLAN|COMMERCIAL,count|UNICARE_PLAN|COMMERCIAL,standard_charge|UNICARE_PLAN|COMMERCIAL|methodology,additional_payer_notes|UNICARE_PLAN|COMMERCIAL,standard_charge|min,standard_charge|max,additional_generic_notes
"Swing Bed Rm chg",22000000,CDM,120,RC,,,Inpatient,,,1139,569.5,,1139,125,,,,,0,"fee schedule","125% of CMS fee schedule",865.64,76,,692.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",854.25,75,,683.40,,,0,"percent of total billed charges","75% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",683.4,60,,546.72,,,0,"percent of total billed charges","60% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",318.92,28,,255.14,,,0,"percent of total billed charges","28% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",1139,100,,,,,0,"fee schedule","100% CMS fee schedule",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",740.35,65,,592.28,,,0,"percent of total billed charges","65% of total billed charges",307.53,27,,246.02,,,0,"percent of total billed charges","27% of total billed charges",1082.05,95,,865.64,,,0,"percent of total billed charges","95% of total billed charges",255.76,22.455,,204.61,,,0,"percent of total billed charges","22.455% of total billed charges",1002.32,88,,801.86,,,0,"percent of total billed charges","88% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",255.76,1139,
"COVID STEP DOWN PEDIATRICS",1100000003,CDM,110,RC,,,Inpatient,,,1421,710.5,,1421,125,,,,,0,"fee schedule","125% of CMS fee schedule",1079.96,76,,863.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",1065.75,75,,852.60,,,0,"percent of total billed charges","75% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",852.6,60,,682.08,,,0,"percent of total billed charges","60% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",397.88,28,,318.30,,,0,"percent of total billed charges","28% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1421,100,,,,,0,"fee schedule","100% CMS fee schedule",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",923.65,65,,738.92,,,0,"percent of total billed charges","65% of total billed charges",383.67,27,,306.94,,,0,"percent of total billed charges","27% of total billed charges",1349.95,95,,1079.96,,,0,"percent of total billed charges","95% of total billed charges",319.09,22.455,,255.27,,,0,"percent of total billed charges","22.455% of total billed charges",1250.48,88,,1000.38,,,0,"percent of total billed charges","88% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",319.09,1421,
"COVID STEPDOWN SPECIAL PROCEDU",1100000007,CDM,110,RC,,,Inpatient,,,1350,675,,1350,125,,,,,0,"fee schedule","125% of CMS fee schedule",1026,76,,820.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",972,72,,777.60,,,0,"percent of total billed charges","72% of total billed charges",1012.5,75,,810.00,,,0,"percent of total billed charges","75% of total billed charges",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",972,72,,777.60,,,0,"percent of total billed charges","72% of total billed charges",810,60,,648.00,,,0,"percent of total billed charges","60% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",378,28,,302.40,,,0,"percent of total billed charges","28% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",1350,100,,,,,0,"fee schedule","100% CMS fee schedule",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",877.5,65,,702.00,,,0,"percent of total billed charges","65% of total billed charges",364.5,27,,291.60,,,0,"percent of total billed charges","27% of total billed charges",1282.5,95,,1026.00,,,0,"percent of total billed charges","95% of total billed charges",303.14,22.455,,242.51,,,0,"percent of total billed charges","22.455% of total billed charges",1188,88,,950.40,,,0,"percent of total billed charges","88% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",303.14,1350,
"COVID STEP DOWN ICU",1130000001,CDM,110,RC,,,Inpatient,,,3146,1573,,3146,125,,,,,0,"fee schedule","125% of CMS fee schedule",2390.96,76,,1912.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2265.12,72,,1812.10,,,0,"percent of total billed charges","72% of total billed charges",2359.5,75,,1887.60,,,0,"percent of total billed charges","75% of total billed charges",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",2265.12,72,,1812.10,,,0,"percent of total billed charges","72% of total billed charges",1887.6,60,,1510.08,,,0,"percent of total billed charges","60% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",880.88,28,,704.70,,,0,"percent of total billed charges","28% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",3146,100,,,,,0,"fee schedule","100% CMS fee schedule",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",2044.9,65,,1635.92,,,0,"percent of total billed charges","65% of total billed charges",849.42,27,,679.54,,,0,"percent of total billed charges","27% of total billed charges",2988.7,95,,2390.96,,,0,"percent of total billed charges","95% of total billed charges",706.43,22.455,,565.14,,,0,"percent of total billed charges","22.455% of total billed charges",2768.48,88,,2214.78,,,0,"percent of total billed charges","88% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",706.43,3146,
"COVID ISOLATION PEDIATRICS",1200000001,CDM,110,RC,,,Inpatient,,,1421,710.5,,1421,125,,,,,0,"fee schedule","125% of CMS fee schedule",1079.96,76,,863.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",1065.75,75,,852.60,,,0,"percent of total billed charges","75% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",852.6,60,,682.08,,,0,"percent of total billed charges","60% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",397.88,28,,318.30,,,0,"percent of total billed charges","28% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1421,100,,,,,0,"fee schedule","100% CMS fee schedule",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",923.65,65,,738.92,,,0,"percent of total billed charges","65% of total billed charges",383.67,27,,306.94,,,0,"percent of total billed charges","27% of total billed charges",1349.95,95,,1079.96,,,0,"percent of total billed charges","95% of total billed charges",319.09,22.455,,255.27,,,0,"percent of total billed charges","22.455% of total billed charges",1250.48,88,,1000.38,,,0,"percent of total billed charges","88% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",319.09,1421,
"COVID ISOLATION SPECIAL PROCED",1200000003,CDM,110,RC,,,Inpatient,,,1350,675,,1350,125,,,,,0,"fee schedule","125% of CMS fee schedule",1026,76,,820.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",972,72,,777.60,,,0,"percent of total billed charges","72% of total billed charges",1012.5,75,,810.00,,,0,"percent of total billed charges","75% of total billed charges",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",972,72,,777.60,,,0,"percent of total billed charges","72% of total billed charges",810,60,,648.00,,,0,"percent of total billed charges","60% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",378,28,,302.40,,,0,"percent of total billed charges","28% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",1350,100,,,,,0,"fee schedule","100% CMS fee schedule",1350,100,,,,,0,"fee schedule","100% of CMS fee schedule",877.5,65,,702.00,,,0,"percent of total billed charges","65% of total billed charges",364.5,27,,291.60,,,0,"percent of total billed charges","27% of total billed charges",1282.5,95,,1026.00,,,0,"percent of total billed charges","95% of total billed charges",303.14,22.455,,242.51,,,0,"percent of total billed charges","22.455% of total billed charges",1188,88,,950.40,,,0,"percent of total billed charges","88% of total billed charges",1215,90,,972.00,,,0,"percent of total billed charges","90% of total billed charges",303.14,1350,
"COVID ISOLATION ICU",1200000005,CDM,110,RC,,,Inpatient,,,3146,1573,,3146,125,,,,,0,"fee schedule","125% of CMS fee schedule",2390.96,76,,1912.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2265.12,72,,1812.10,,,0,"percent of total billed charges","72% of total billed charges",2359.5,75,,1887.60,,,0,"percent of total billed charges","75% of total billed charges",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",2265.12,72,,1812.10,,,0,"percent of total billed charges","72% of total billed charges",1887.6,60,,1510.08,,,0,"percent of total billed charges","60% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",880.88,28,,704.70,,,0,"percent of total billed charges","28% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",3146,100,,,,,0,"fee schedule","100% CMS fee schedule",3146,100,,,,,0,"fee schedule","100% of CMS fee schedule",2044.9,65,,1635.92,,,0,"percent of total billed charges","65% of total billed charges",849.42,27,,679.54,,,0,"percent of total billed charges","27% of total billed charges",2988.7,95,,2390.96,,,0,"percent of total billed charges","95% of total billed charges",706.43,22.455,,565.14,,,0,"percent of total billed charges","22.455% of total billed charges",2768.48,88,,2214.78,,,0,"percent of total billed charges","88% of total billed charges",2831.4,90,,2265.12,,,0,"percent of total billed charges","90% of total billed charges",706.43,3146,
"COVID ISOLATION ED",1710000001,CDM,110,RC,,,Inpatient,,,1421,710.5,,1421,125,,,,,0,"fee schedule","125% of CMS fee schedule",1079.96,76,,863.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",1065.75,75,,852.60,,,0,"percent of total billed charges","75% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",852.6,60,,682.08,,,0,"percent of total billed charges","60% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",397.88,28,,318.30,,,0,"percent of total billed charges","28% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1421,100,,,,,0,"fee schedule","100% CMS fee schedule",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",923.65,65,,738.92,,,0,"percent of total billed charges","65% of total billed charges",383.67,27,,306.94,,,0,"percent of total billed charges","27% of total billed charges",1349.95,95,,1079.96,,,0,"percent of total billed charges","95% of total billed charges",319.09,22.455,,255.27,,,0,"percent of total billed charges","22.455% of total billed charges",1250.48,88,,1000.38,,,0,"percent of total billed charges","88% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",319.09,1421,
"COVID STEP DOWN ED",1730000001,CDM,110,RC,,,Inpatient,,,1421,710.5,,1421,125,,,,,0,"fee schedule","125% of CMS fee schedule",1079.96,76,,863.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",1065.75,75,,852.60,,,0,"percent of total billed charges","75% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1023.12,72,,818.50,,,0,"percent of total billed charges","72% of total billed charges",852.6,60,,682.08,,,0,"percent of total billed charges","60% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",397.88,28,,318.30,,,0,"percent of total billed charges","28% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",1421,100,,,,,0,"fee schedule","100% CMS fee schedule",1421,100,,,,,0,"fee schedule","100% of CMS fee schedule",923.65,65,,738.92,,,0,"percent of total billed charges","65% of total billed charges",383.67,27,,306.94,,,0,"percent of total billed charges","27% of total billed charges",1349.95,95,,1079.96,,,0,"percent of total billed charges","95% of total billed charges",319.09,22.455,,255.27,,,0,"percent of total billed charges","22.455% of total billed charges",1250.48,88,,1000.38,,,0,"percent of total billed charges","88% of total billed charges",1278.9,90,,1023.12,,,0,"percent of total billed charges","90% of total billed charges",319.09,1421,
"PEDIATRIC ROOM&BOARD PRIVATE",2500000001,CDM,113,RC,,,Inpatient,,,772.85,386.425,,772.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",587.37,76,,469.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",556.45,72,,445.16,,,0,"percent of total billed charges","72% of total billed charges",579.64,75,,463.71,,,0,"percent of total billed charges","75% of total billed charges",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",556.45,72,,445.16,,,0,"percent of total billed charges","72% of total billed charges",463.71,60,,370.97,,,0,"percent of total billed charges","60% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",216.4,28,,173.12,,,0,"percent of total billed charges","28% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",772.85,100,,,,,0,"fee schedule","100% CMS fee schedule",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",502.35,65,,401.88,,,0,"percent of total billed charges","65% of total billed charges",208.67,27,,166.94,,,0,"percent of total billed charges","27% of total billed charges",734.21,95,,587.37,,,0,"percent of total billed charges","95% of total billed charges",173.54,22.455,,138.83,,,0,"percent of total billed charges","22.455% of total billed charges",680.11,88,,544.09,,,0,"percent of total billed charges","88% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",173.54,772.85,
"MED/SURG RESPITE ROOM & BOARD",2500000003,CDM,115,RC,,,Inpatient,,,772.85,386.425,,772.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",587.37,76,,469.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",556.45,72,,445.16,,,0,"percent of total billed charges","72% of total billed charges",579.64,75,,463.71,,,0,"percent of total billed charges","75% of total billed charges",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",556.45,72,,445.16,,,0,"percent of total billed charges","72% of total billed charges",463.71,60,,370.97,,,0,"percent of total billed charges","60% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",216.4,28,,173.12,,,0,"percent of total billed charges","28% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",772.85,100,,,,,0,"fee schedule","100% CMS fee schedule",772.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",502.35,65,,401.88,,,0,"percent of total billed charges","65% of total billed charges",208.67,27,,166.94,,,0,"percent of total billed charges","27% of total billed charges",734.21,95,,587.37,,,0,"percent of total billed charges","95% of total billed charges",173.54,22.455,,138.83,,,0,"percent of total billed charges","22.455% of total billed charges",680.11,88,,544.09,,,0,"percent of total billed charges","88% of total billed charges",695.57,90,,556.46,,,0,"percent of total billed charges","90% of total billed charges",173.54,772.85,
"PEDIATRIC ROOM&BOARD TELEMETRY",2500000005,CDM,120,RC,,,Inpatient,,,1065.02,532.51,,1065.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",809.42,76,,647.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",766.81,72,,613.45,,,0,"percent of total billed charges","72% of total billed charges",798.77,75,,639.02,,,0,"percent of total billed charges","75% of total billed charges",1065.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",766.81,72,,613.45,,,0,"percent of total billed charges","72% of total billed charges",639.01,60,,511.21,,,0,"percent of total billed charges","60% of total billed charges",958.52,90,,766.82,,,0,"percent of total billed charges","90% of total billed charges",298.21,28,,238.57,,,0,"percent of total billed charges","28% of total billed charges",958.52,90,,766.82,,,0,"percent of total billed charges","90% of total billed charges",1065.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",1065.02,100,,,,,0,"fee schedule","100% CMS fee schedule",1065.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",692.26,65,,553.81,,,0,"percent of total billed charges","65% of total billed charges",287.56,27,,230.05,,,0,"percent of total billed charges","27% of total billed charges",1011.77,95,,809.42,,,0,"percent of total billed charges","95% of total billed charges",239.15,22.455,,191.32,,,0,"percent of total billed charges","22.455% of total billed charges",937.22,88,,749.78,,,0,"percent of total billed charges","88% of total billed charges",958.52,90,,766.82,,,0,"percent of total billed charges","90% of total billed charges",239.15,1065.02,
"MED/SURG ROOM&BOARD SEMI-PVT",2500000007,CDM,120,RC,,,Inpatient,,,1139,569.5,,1139,125,,,,,0,"fee schedule","125% of CMS fee schedule",865.64,76,,692.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",854.25,75,,683.40,,,0,"percent of total billed charges","75% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",683.4,60,,546.72,,,0,"percent of total billed charges","60% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",318.92,28,,255.14,,,0,"percent of total billed charges","28% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",1139,100,,,,,0,"fee schedule","100% CMS fee schedule",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",740.35,65,,592.28,,,0,"percent of total billed charges","65% of total billed charges",307.53,27,,246.02,,,0,"percent of total billed charges","27% of total billed charges",1082.05,95,,865.64,,,0,"percent of total billed charges","95% of total billed charges",255.76,22.455,,204.61,,,0,"percent of total billed charges","22.455% of total billed charges",1002.32,88,,801.86,,,0,"percent of total billed charges","88% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",255.76,1139,
"MED/SURG ROOM&BOARD TELEMETRY",2500000009,CDM,120,RC,,,Inpatient,,,1012,506,,1012,125,,,,,0,"fee schedule","125% of CMS fee schedule",769.12,76,,615.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",728.64,72,,582.91,,,0,"percent of total billed charges","72% of total billed charges",759,75,,607.20,,,0,"percent of total billed charges","75% of total billed charges",1012,100,,,,,0,"fee schedule","100% of CMS fee schedule",728.64,72,,582.91,,,0,"percent of total billed charges","72% of total billed charges",607.2,60,,485.76,,,0,"percent of total billed charges","60% of total billed charges",910.8,90,,728.64,,,0,"percent of total billed charges","90% of total billed charges",283.36,28,,226.69,,,0,"percent of total billed charges","28% of total billed charges",910.8,90,,728.64,,,0,"percent of total billed charges","90% of total billed charges",1012,100,,,,,0,"fee schedule","100% of CMS fee schedule",1012,100,,,,,0,"fee schedule","100% CMS fee schedule",1012,100,,,,,0,"fee schedule","100% of CMS fee schedule",657.8,65,,526.24,,,0,"percent of total billed charges","65% of total billed charges",273.24,27,,218.59,,,0,"percent of total billed charges","27% of total billed charges",961.4,95,,769.12,,,0,"percent of total billed charges","95% of total billed charges",227.24,22.455,,181.79,,,0,"percent of total billed charges","22.455% of total billed charges",890.56,88,,712.45,,,0,"percent of total billed charges","88% of total billed charges",910.8,90,,728.64,,,0,"percent of total billed charges","90% of total billed charges",227.24,1012,
"LABOR & DELIVERY ROOM & BOARD",2500000011,CDM,120,RC,,,Inpatient,,,1139,569.5,,1139,125,,,,,0,"fee schedule","125% of CMS fee schedule",865.64,76,,692.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",854.25,75,,683.40,,,0,"percent of total billed charges","75% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",683.4,60,,546.72,,,0,"percent of total billed charges","60% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",318.92,28,,255.14,,,0,"percent of total billed charges","28% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",1139,100,,,,,0,"fee schedule","100% CMS fee schedule",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",740.35,65,,592.28,,,0,"percent of total billed charges","65% of total billed charges",307.53,27,,246.02,,,0,"percent of total billed charges","27% of total billed charges",1082.05,95,,865.64,,,0,"percent of total billed charges","95% of total billed charges",255.76,22.455,,204.61,,,0,"percent of total billed charges","22.455% of total billed charges",1002.32,88,,801.86,,,0,"percent of total billed charges","88% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",255.76,1139,
"POST PARTUM ROOM & BOARD",2500000013,CDM,120,RC,,,Inpatient,,,1139,569.5,,1139,125,,,,,0,"fee schedule","125% of CMS fee schedule",865.64,76,,692.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",854.25,75,,683.40,,,0,"percent of total billed charges","75% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.08,72,,656.06,,,0,"percent of total billed charges","72% of total billed charges",683.4,60,,546.72,,,0,"percent of total billed charges","60% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",318.92,28,,255.14,,,0,"percent of total billed charges","28% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",1139,100,,,,,0,"fee schedule","100% CMS fee schedule",1139,100,,,,,0,"fee schedule","100% of CMS fee schedule",740.35,65,,592.28,,,0,"percent of total billed charges","65% of total billed charges",307.53,27,,246.02,,,0,"percent of total billed charges","27% of total billed charges",1082.05,95,,865.64,,,0,"percent of total billed charges","95% of total billed charges",255.76,22.455,,204.61,,,0,"percent of total billed charges","22.455% of total billed charges",1002.32,88,,801.86,,,0,"percent of total billed charges","88% of total billed charges",1025.1,90,,820.08,,,0,"percent of total billed charges","90% of total billed charges",255.76,1139,
"PEDIATRIC ROOM&BOARD SEMI-PVT",2500000015,CDM,123,RC,,,Inpatient,,,1087,543.5,,1087,125,,,,,0,"fee schedule","125% of CMS fee schedule",826.12,76,,660.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",782.64,72,,626.11,,,0,"percent of total billed charges","72% of total billed charges",815.25,75,,652.20,,,0,"percent of total billed charges","75% of total billed charges",1087,100,,,,,0,"fee schedule","100% of CMS fee schedule",782.64,72,,626.11,,,0,"percent of total billed charges","72% of total billed charges",652.2,60,,521.76,,,0,"percent of total billed charges","60% of total billed charges",978.3,90,,782.64,,,0,"percent of total billed charges","90% of total billed charges",304.36,28,,243.49,,,0,"percent of total billed charges","28% of total billed charges",978.3,90,,782.64,,,0,"percent of total billed charges","90% of total billed charges",1087,100,,,,,0,"fee schedule","100% of CMS fee schedule",1087,100,,,,,0,"fee schedule","100% CMS fee schedule",1087,100,,,,,0,"fee schedule","100% of CMS fee schedule",706.55,65,,565.24,,,0,"percent of total billed charges","65% of total billed charges",293.49,27,,234.79,,,0,"percent of total billed charges","27% of total billed charges",1032.65,95,,826.12,,,0,"percent of total billed charges","95% of total billed charges",244.09,22.455,,195.27,,,0,"percent of total billed charges","22.455% of total billed charges",956.56,88,,765.25,,,0,"percent of total billed charges","88% of total billed charges",978.3,90,,782.64,,,0,"percent of total billed charges","90% of total billed charges",244.09,1087,
"NURSERY LEVEL 1",2500000017,CDM,171,RC,,,Inpatient,,,384,192,,384,125,,,,,0,"fee schedule","125% of CMS fee schedule",291.84,76,,233.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",276.48,72,,221.18,,,0,"percent of total billed charges","72% of total billed charges",288,75,,230.40,,,0,"percent of total billed charges","75% of total billed charges",384,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.48,72,,221.18,,,0,"percent of total billed charges","72% of total billed charges",230.4,60,,184.32,,,0,"percent of total billed charges","60% of total billed charges",345.6,90,,276.48,,,0,"percent of total billed charges","90% of total billed charges",107.52,28,,86.02,,,0,"percent of total billed charges","28% of total billed charges",345.6,90,,276.48,,,0,"percent of total billed charges","90% of total billed charges",384,100,,,,,0,"fee schedule","100% of CMS fee schedule",384,100,,,,,0,"fee schedule","100% CMS fee schedule",384,100,,,,,0,"fee schedule","100% of CMS fee schedule",249.6,65,,199.68,,,0,"percent of total billed charges","65% of total billed charges",103.68,27,,82.94,,,0,"percent of total billed charges","27% of total billed charges",364.8,95,,291.84,,,0,"percent of total billed charges","95% of total billed charges",86.23,22.455,,68.98,,,0,"percent of total billed charges","22.455% of total billed charges",337.92,88,,270.34,,,0,"percent of total billed charges","88% of total billed charges",345.6,90,,276.48,,,0,"percent of total billed charges","90% of total billed charges",86.23,384,
"NURSERY LEVEL 2",2500000019,CDM,172,RC,,,Inpatient,,,2323,1161.5,,2323,125,,,,,0,"fee schedule","125% of CMS fee schedule",1765.48,76,,1412.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1672.56,72,,1338.05,,,0,"percent of total billed charges","72% of total billed charges",1742.25,75,,1393.80,,,0,"percent of total billed charges","75% of total billed charges",2323,100,,,,,0,"fee schedule","100% of CMS fee schedule",1672.56,72,,1338.05,,,0,"percent of total billed charges","72% of total billed charges",1393.8,60,,1115.04,,,0,"percent of total billed charges","60% of total billed charges",2090.7,90,,1672.56,,,0,"percent of total billed charges","90% of total billed charges",650.44,28,,520.35,,,0,"percent of total billed charges","28% of total billed charges",2090.7,90,,1672.56,,,0,"percent of total billed charges","90% of total billed charges",2323,100,,,,,0,"fee schedule","100% of CMS fee schedule",2323,100,,,,,0,"fee schedule","100% CMS fee schedule",2323,100,,,,,0,"fee schedule","100% of CMS fee schedule",1509.95,65,,1207.96,,,0,"percent of total billed charges","65% of total billed charges",627.21,27,,501.77,,,0,"percent of total billed charges","27% of total billed charges",2206.85,95,,1765.48,,,0,"percent of total billed charges","95% of total billed charges",521.63,22.455,,417.30,,,0,"percent of total billed charges","22.455% of total billed charges",2044.24,88,,1635.39,,,0,"percent of total billed charges","88% of total billed charges",2090.7,90,,1672.56,,,0,"percent of total billed charges","90% of total billed charges",521.63,2323,
"NURSERY LEVEL 3",2500000021,CDM,173,RC,,,Inpatient,,,706.7,353.35,,706.7,125,,,,,0,"fee schedule","125% of CMS fee schedule",537.09,76,,429.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",508.82,72,,407.06,,,0,"percent of total billed charges","72% of total billed charges",530.03,75,,424.02,,,0,"percent of total billed charges","75% of total billed charges",706.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",508.82,72,,407.06,,,0,"percent of total billed charges","72% of total billed charges",424.02,60,,339.22,,,0,"percent of total billed charges","60% of total billed charges",636.03,90,,508.82,,,0,"percent of total billed charges","90% of total billed charges",197.88,28,,158.30,,,0,"percent of total billed charges","28% of total billed charges",636.03,90,,508.82,,,0,"percent of total billed charges","90% of total billed charges",706.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",706.7,100,,,,,0,"fee schedule","100% CMS fee schedule",706.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",459.36,65,,367.49,,,0,"percent of total billed charges","65% of total billed charges",190.81,27,,152.65,,,0,"percent of total billed charges","27% of total billed charges",671.37,95,,537.10,,,0,"percent of total billed charges","95% of total billed charges",158.69,22.455,,126.95,,,0,"percent of total billed charges","22.455% of total billed charges",621.9,88,,497.52,,,0,"percent of total billed charges","88% of total billed charges",636.03,90,,508.82,,,0,"percent of total billed charges","90% of total billed charges",158.69,706.7,
"ICU ROOM & BOARD",2500000023,CDM,200,RC,,,Inpatient,,,2259,1129.5,,2259,125,,,,,0,"fee schedule","125% of CMS fee schedule",1716.84,76,,1373.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1626.48,72,,1301.18,,,0,"percent of total billed charges","72% of total billed charges",1694.25,75,,1355.40,,,0,"percent of total billed charges","75% of total billed charges",2259,100,,,,,0,"fee schedule","100% of CMS fee schedule",1626.48,72,,1301.18,,,0,"percent of total billed charges","72% of total billed charges",1355.4,60,,1084.32,,,0,"percent of total billed charges","60% of total billed charges",2033.1,90,,1626.48,,,0,"percent of total billed charges","90% of total billed charges",632.52,28,,506.02,,,0,"percent of total billed charges","28% of total billed charges",2033.1,90,,1626.48,,,0,"percent of total billed charges","90% of total billed charges",2259,100,,,,,0,"fee schedule","100% of CMS fee schedule",2259,100,,,,,0,"fee schedule","100% CMS fee schedule",2259,100,,,,,0,"fee schedule","100% of CMS fee schedule",1468.35,65,,1174.68,,,0,"percent of total billed charges","65% of total billed charges",609.93,27,,487.94,,,0,"percent of total billed charges","27% of total billed charges",2146.05,95,,1716.84,,,0,"percent of total billed charges","95% of total billed charges",507.26,22.455,,405.81,,,0,"percent of total billed charges","22.455% of total billed charges",1987.92,88,,1590.34,,,0,"percent of total billed charges","88% of total billed charges",2033.1,90,,1626.48,,,0,"percent of total billed charges","90% of total billed charges",507.26,2259,
"ACET 200MG/ML 6G/30ML 30ML VIA",2500000025,CDM,250,RC,J0132,HCPCS,Outpatient,,,950.36,475.18,U8,950.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",722.27,76,,577.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.6,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",7.6,350,,,,,0,"fee schedule","350% of BCBS fee schedule",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.17,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",427.66,45,,342.13,,,0,"percent of total billed charges","45% of total billed charges",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",950.36,100,,,,,0,"fee schedule","100% CMS fee schedule",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",617.73,65,,494.18,,,0,"percent of total billed charges","65% of total billed charges",419.11,27,,335.29,,,0,"percent of total billed charges","27% of total billed charges",902.84,95,,722.27,,,0,"percent of total billed charges","95% of total billed charges",950.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",836.32,88,,669.06,,,0,"percent of total billed charges","88% of total billed charges",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",2.17,950.36,
"ACET 200MG/ML 6G/30ML 30ML VIA",2500000026,CDM,250,RC,J0132,HCPCS,Outpatient,,,950.36,475.18,U8,950.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",722.27,76,,577.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.6,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",7.6,350,,,,,0,"fee schedule","350% of BCBS fee schedule",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.6,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.17,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",427.66,45,,342.13,,,0,"percent of total billed charges","45% of total billed charges",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",950.36,100,,,,,0,"fee schedule","100% CMS fee schedule",950.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",617.73,65,,494.18,,,0,"percent of total billed charges","65% of total billed charges",419.11,27,,335.29,,,0,"percent of total billed charges","27% of total billed charges",902.84,95,,722.27,,,0,"percent of total billed charges","95% of total billed charges",950.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",836.32,88,,669.06,,,0,"percent of total billed charges","88% of total billed charges",855.32,90,,684.26,,,0,"percent of total billed charges","90% of total billed charges",2.17,950.36,
"ALBUT SUL 0.021% 0.63MG/3ML NE",2500000033,CDM,250,RC,J7613,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.28,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.28,350,,0.07,0.06,0.08,"1 through 10","fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.28,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.08,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,9.72,8.86,27.86,"1 through 10","percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,0.33,0.22,0.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,8.60,4.89,14.94,80,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,0.16,0.16,0.16,"1 through 10","fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.08,9.92,
"ALBUT SUL 0.021% 0.63MG/3ML NE",2500000034,CDM,250,RC,J7613,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.28,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.28,350,,0.07,0.06,0.08,"1 through 10","fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.28,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.08,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,9.72,8.86,27.86,"1 through 10","percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,0.33,0.22,0.57,"1 through 10","fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,8.60,4.89,14.94,80,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,0.16,0.16,0.16,"1 through 10","fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.08,9.92,
"AMOX/CLAV 200MG/5ML SUS 75ML S",2500000041,CDM,250,RC,,,Outpatient,,,93.71,46.855,,93.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",71.22,76,,56.98,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",70.28,75,,56.22,,,0,"percent of total billed charges","75% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",56.23,60,,44.98,,,0,"percent of total billed charges","60% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",42.17,45,,33.74,,,0,"percent of total billed charges","45% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.91,65,,48.73,,,0,"percent of total billed charges","65% of total billed charges",41.33,27,,33.06,,,0,"percent of total billed charges","27% of total billed charges",89.02,95,,71.22,,,0,"percent of total billed charges","95% of total billed charges",93.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",82.46,88,,65.97,,,0,"percent of total billed charges","88% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",41.33,93.71,
"AMOX/CLAV 200MG/5ML SUS 75ML S",2500000042,CDM,250,RC,,,Outpatient,,,93.71,46.855,,93.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",71.22,76,,56.98,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",70.28,75,,56.22,,,0,"percent of total billed charges","75% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",56.23,60,,44.98,,,0,"percent of total billed charges","60% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",42.17,45,,33.74,,,0,"percent of total billed charges","45% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.91,65,,48.73,,,0,"percent of total billed charges","65% of total billed charges",41.33,27,,33.06,,,0,"percent of total billed charges","27% of total billed charges",89.02,95,,71.22,,,0,"percent of total billed charges","95% of total billed charges",93.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",82.46,88,,65.97,,,0,"percent of total billed charges","88% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",41.33,93.71,
"AMOX/CLAV 600MG/5ML SUS 75ML S",2500000045,CDM,250,RC,,,Outpatient,,,146.63,73.315,,146.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",111.44,76,,89.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",109.97,75,,87.98,,,0,"percent of total billed charges","75% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",87.98,60,,70.38,,,0,"percent of total billed charges","60% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",65.98,45,,52.78,,,0,"percent of total billed charges","45% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.31,65,,76.25,,,0,"percent of total billed charges","65% of total billed charges",64.66,27,,51.73,,,0,"percent of total billed charges","27% of total billed charges",139.3,95,,111.44,,,0,"percent of total billed charges","95% of total billed charges",146.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",129.03,88,,103.22,,,0,"percent of total billed charges","88% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",64.66,146.63,
"AMOX/CLAV 600MG/5ML SUS 75ML S",2500000046,CDM,250,RC,,,Outpatient,,,146.63,73.315,,146.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",111.44,76,,89.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",109.97,75,,87.98,,,0,"percent of total billed charges","75% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",87.98,60,,70.38,,,0,"percent of total billed charges","60% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",65.98,45,,52.78,,,0,"percent of total billed charges","45% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.31,65,,76.25,,,0,"percent of total billed charges","65% of total billed charges",64.66,27,,51.73,,,0,"percent of total billed charges","27% of total billed charges",139.3,95,,111.44,,,0,"percent of total billed charges","95% of total billed charges",146.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",129.03,88,,103.22,,,0,"percent of total billed charges","88% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",64.66,146.63,
"AUGMENTN 200MG/28.5MG/5ML SUSP",2500000061,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AUGMENTN 200MG/28.5MG/5ML SUSP",2500000062,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"CAFF/ SOD BENZOATE 250MG/2ML",2500000073,CDM,250,RC,,,Outpatient,,,69.25,34.625,,69.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",52.63,76,,42.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",49.86,72,,39.89,,,0,"percent of total billed charges","72% of total billed charges",51.94,75,,41.55,,,0,"percent of total billed charges","75% of total billed charges",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.86,72,,39.89,,,0,"percent of total billed charges","72% of total billed charges",41.55,60,,33.24,,,0,"percent of total billed charges","60% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",31.16,45,,24.93,,,0,"percent of total billed charges","45% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.25,100,,,,,0,"fee schedule","100% CMS fee schedule",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.01,65,,36.01,,,0,"percent of total billed charges","65% of total billed charges",30.54,27,,24.43,,,0,"percent of total billed charges","27% of total billed charges",65.79,95,,52.63,,,0,"percent of total billed charges","95% of total billed charges",69.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.94,88,,48.75,,,0,"percent of total billed charges","88% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",30.54,69.25,
"CAFF/ SOD BENZOATE 250MG/2ML",2500000074,CDM,250,RC,,,Outpatient,,,69.25,34.625,,69.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",52.63,76,,42.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",49.86,72,,39.89,,,0,"percent of total billed charges","72% of total billed charges",51.94,75,,41.55,,,0,"percent of total billed charges","75% of total billed charges",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.86,72,,39.89,,,0,"percent of total billed charges","72% of total billed charges",41.55,60,,33.24,,,0,"percent of total billed charges","60% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",31.16,45,,24.93,,,0,"percent of total billed charges","45% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.25,100,,,,,0,"fee schedule","100% CMS fee schedule",69.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.01,65,,36.01,,,0,"percent of total billed charges","65% of total billed charges",30.54,27,,24.43,,,0,"percent of total billed charges","27% of total billed charges",65.79,95,,52.63,,,0,"percent of total billed charges","95% of total billed charges",69.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.94,88,,48.75,,,0,"percent of total billed charges","88% of total billed charges",62.33,90,,49.86,,,0,"percent of total billed charges","90% of total billed charges",30.54,69.25,
"CIPROFLXA CM 0.3 OPHTH SOL 5ML",2500000085,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"CIPROFLXA CM 0.3 OPHTH SOL 5ML",2500000086,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"GLUC 1.5 237 MLS KCAL 356 LIQD",2500000105,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"GLUC 1.5 237 MLS KCAL 356 LIQD",2500000106,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"LACTULOSE 100GR/150 ML ORL SOL",2500000117,CDM,250,RC,,,Outpatient,,,7.75,3.875,,7.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.89,76,,4.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.58,72,,4.46,,,0,"percent of total billed charges","72% of total billed charges",5.81,75,,4.65,,,0,"percent of total billed charges","75% of total billed charges",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.58,72,,4.46,,,0,"percent of total billed charges","72% of total billed charges",4.65,60,,3.72,,,0,"percent of total billed charges","60% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",3.49,45,,2.79,,,0,"percent of total billed charges","45% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.75,100,,,,,0,"fee schedule","100% CMS fee schedule",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,65,,4.03,,,0,"percent of total billed charges","65% of total billed charges",3.42,27,,2.74,,,0,"percent of total billed charges","27% of total billed charges",7.36,95,,5.89,,,0,"percent of total billed charges","95% of total billed charges",7.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.82,88,,5.46,,,0,"percent of total billed charges","88% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",3.42,7.75,
"LACTULOSE 100GR/150 ML ORL SOL",2500000118,CDM,250,RC,,,Outpatient,,,7.75,3.875,,7.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.89,76,,4.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.58,72,,4.46,,,0,"percent of total billed charges","72% of total billed charges",5.81,75,,4.65,,,0,"percent of total billed charges","75% of total billed charges",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.58,72,,4.46,,,0,"percent of total billed charges","72% of total billed charges",4.65,60,,3.72,,,0,"percent of total billed charges","60% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",3.49,45,,2.79,,,0,"percent of total billed charges","45% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.75,100,,,,,0,"fee schedule","100% CMS fee schedule",7.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.04,65,,4.03,,,0,"percent of total billed charges","65% of total billed charges",3.42,27,,2.74,,,0,"percent of total billed charges","27% of total billed charges",7.36,95,,5.89,,,0,"percent of total billed charges","95% of total billed charges",7.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.82,88,,5.46,,,0,"percent of total billed charges","88% of total billed charges",6.98,90,,5.58,,,0,"percent of total billed charges","90% of total billed charges",3.42,7.75,
"LIDOC 2%  1:100,000 INJ 20ML",2500000121,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LIDOC 2%  1:100,000 INJ 20ML",2500000122,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NEO/POLY B/BACI ZN/HC 1% OINT",2500000129,CDM,250,RC,,,Outpatient,,,86,43,,86,125,,,,,0,"fee schedule","125% of CMS fee schedule",65.36,76,,52.29,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.92,72,,49.54,,,0,"percent of total billed charges","72% of total billed charges",64.5,75,,51.60,,,0,"percent of total billed charges","75% of total billed charges",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.92,72,,49.54,,,0,"percent of total billed charges","72% of total billed charges",51.6,60,,41.28,,,0,"percent of total billed charges","60% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",38.7,45,,30.96,,,0,"percent of total billed charges","45% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,100,,,,,0,"fee schedule","100% CMS fee schedule",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.9,65,,44.72,,,0,"percent of total billed charges","65% of total billed charges",37.93,27,,30.34,,,0,"percent of total billed charges","27% of total billed charges",81.7,95,,65.36,,,0,"percent of total billed charges","95% of total billed charges",86,75,,,,,0,"fee schedule","75% of CMS fee schedule",75.68,88,,60.54,,,0,"percent of total billed charges","88% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",37.93,86,
"NEO/POLY B/BACI ZN/HC 1% OINT",2500000130,CDM,250,RC,,,Outpatient,,,86,43,,86,125,,,,,0,"fee schedule","125% of CMS fee schedule",65.36,76,,52.29,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.92,72,,49.54,,,0,"percent of total billed charges","72% of total billed charges",64.5,75,,51.60,,,0,"percent of total billed charges","75% of total billed charges",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.92,72,,49.54,,,0,"percent of total billed charges","72% of total billed charges",51.6,60,,41.28,,,0,"percent of total billed charges","60% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",38.7,45,,30.96,,,0,"percent of total billed charges","45% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,100,,,,,0,"fee schedule","100% CMS fee schedule",86,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.9,65,,44.72,,,0,"percent of total billed charges","65% of total billed charges",37.93,27,,30.34,,,0,"percent of total billed charges","27% of total billed charges",81.7,95,,65.36,,,0,"percent of total billed charges","95% of total billed charges",86,75,,,,,0,"fee schedule","75% of CMS fee schedule",75.68,88,,60.54,,,0,"percent of total billed charges","88% of total billed charges",77.4,90,,61.92,,,0,"percent of total billed charges","90% of total billed charges",37.93,86,
"NEOMYCIN  BACITRAICN POLYMYCN",2500000133,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NEOMYCIN  BACITRAICN POLYMYCN",2500000134,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NYSTATIN/TRIAMCINOLONE CRM 15G",2500000137,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"NYSTATIN/TRIAMCINOLONE CRM 15G",2500000138,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PENICLN V POTASIUM 250/5 200ML",2500000141,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"PENICLN V POTASIUM 250/5 200ML",2500000142,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"PHENYLEPHRINE 0.5% NASAL SOLUT",2500000149,CDM,250,RC,,,Outpatient,,,140.02,70.01,,140.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",106.42,76,,85.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",100.81,72,,80.65,,,0,"percent of total billed charges","72% of total billed charges",105.02,75,,84.02,,,0,"percent of total billed charges","75% of total billed charges",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",100.81,72,,80.65,,,0,"percent of total billed charges","72% of total billed charges",84.01,60,,67.21,,,0,"percent of total billed charges","60% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",63.01,45,,50.41,,,0,"percent of total billed charges","45% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.02,100,,,,,0,"fee schedule","100% CMS fee schedule",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.01,65,,72.81,,,0,"percent of total billed charges","65% of total billed charges",61.75,27,,49.40,,,0,"percent of total billed charges","27% of total billed charges",133.02,95,,106.42,,,0,"percent of total billed charges","95% of total billed charges",140.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",123.22,88,,98.58,,,0,"percent of total billed charges","88% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",61.75,140.02,
"PHENYLEPHRINE 0.5% NASAL SOLUT",2500000150,CDM,250,RC,,,Outpatient,,,140.02,70.01,,140.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",106.42,76,,85.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",100.81,72,,80.65,,,0,"percent of total billed charges","72% of total billed charges",105.02,75,,84.02,,,0,"percent of total billed charges","75% of total billed charges",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",100.81,72,,80.65,,,0,"percent of total billed charges","72% of total billed charges",84.01,60,,67.21,,,0,"percent of total billed charges","60% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",63.01,45,,50.41,,,0,"percent of total billed charges","45% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.02,100,,,,,0,"fee schedule","100% CMS fee schedule",140.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.01,65,,72.81,,,0,"percent of total billed charges","65% of total billed charges",61.75,27,,49.40,,,0,"percent of total billed charges","27% of total billed charges",133.02,95,,106.42,,,0,"percent of total billed charges","95% of total billed charges",140.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",123.22,88,,98.58,,,0,"percent of total billed charges","88% of total billed charges",126.02,90,,100.82,,,0,"percent of total billed charges","90% of total billed charges",61.75,140.02,
"POTASSCHLORI 10 MEG / 50ML INJ",2500000157,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"POTASSCHLORI 10 MEG / 50ML INJ",2500000158,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"SOD BICARBONATE 8.4% 10ML INJ",2500000162,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"SOD BICARBONATE 8.4% 10ML INJ",2500000163,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"SOD CHL BACTERIOSTA F INJ 10ML",2500000166,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SOD CHL BACTERIOSTA F INJ 10ML",2500000167,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SODIUM PHOSPHTE 3MM/ML 5ML INJ",2500000170,CDM,250,RC,,,Outpatient,,,59.25,29.625,,59.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",45.03,76,,36.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.66,72,,34.13,,,0,"percent of total billed charges","72% of total billed charges",44.44,75,,35.55,,,0,"percent of total billed charges","75% of total billed charges",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.66,72,,34.13,,,0,"percent of total billed charges","72% of total billed charges",35.55,60,,28.44,,,0,"percent of total billed charges","60% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",26.66,45,,21.33,,,0,"percent of total billed charges","45% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.25,100,,,,,0,"fee schedule","100% CMS fee schedule",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.51,65,,30.81,,,0,"percent of total billed charges","65% of total billed charges",26.13,27,,20.90,,,0,"percent of total billed charges","27% of total billed charges",56.29,95,,45.03,,,0,"percent of total billed charges","95% of total billed charges",59.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",52.14,88,,41.71,,,0,"percent of total billed charges","88% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",26.13,59.25,
"SODIUM PHOSPHTE 3MM/ML 5ML INJ",2500000171,CDM,250,RC,,,Outpatient,,,59.25,29.625,,59.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",45.03,76,,36.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.66,72,,34.13,,,0,"percent of total billed charges","72% of total billed charges",44.44,75,,35.55,,,0,"percent of total billed charges","75% of total billed charges",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.66,72,,34.13,,,0,"percent of total billed charges","72% of total billed charges",35.55,60,,28.44,,,0,"percent of total billed charges","60% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",26.66,45,,21.33,,,0,"percent of total billed charges","45% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.25,100,,,,,0,"fee schedule","100% CMS fee schedule",59.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.51,65,,30.81,,,0,"percent of total billed charges","65% of total billed charges",26.13,27,,20.90,,,0,"percent of total billed charges","27% of total billed charges",56.29,95,,45.03,,,0,"percent of total billed charges","95% of total billed charges",59.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",52.14,88,,41.71,,,0,"percent of total billed charges","88% of total billed charges",53.33,90,,42.66,,,0,"percent of total billed charges","90% of total billed charges",26.13,59.25,
"STER WTR IRR W/SET PORT 1000ML",2500000174,CDM,250,RC,,,Outpatient,,,47,23.5,,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",35.25,75,,28.20,,,0,"percent of total billed charges","75% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",28.2,60,,22.56,,,0,"percent of total billed charges","60% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,16.58,,,0,"percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",20.73,47,
"STER WTR IRR W/SET PORT 1000ML",2500000175,CDM,250,RC,,,Outpatient,,,47,23.5,,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",35.25,75,,28.20,,,0,"percent of total billed charges","75% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",28.2,60,,22.56,,,0,"percent of total billed charges","60% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,16.58,,,0,"percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",20.73,47,
"STER WTR IRR W/SET PORT 500ML",2500000178,CDM,250,RC,,,Outpatient,,,47,23.5,,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",35.25,75,,28.20,,,0,"percent of total billed charges","75% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",28.2,60,,22.56,,,0,"percent of total billed charges","60% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,16.58,,,0,"percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",20.73,47,
"STER WTR IRR W/SET PORT 500ML",2500000179,CDM,250,RC,,,Outpatient,,,47,23.5,,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",35.25,75,,28.20,,,0,"percent of total billed charges","75% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",28.2,60,,22.56,,,0,"percent of total billed charges","60% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,16.58,,,0,"percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",20.73,47,
"TETRACAINE 0.5% OPHTH SOL 15ML",2500000186,CDM,250,RC,,,Outpatient,,,125.96,62.98,,125.96,125,,,,,0,"fee schedule","125% of CMS fee schedule",95.73,76,,76.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",90.69,72,,72.55,,,0,"percent of total billed charges","72% of total billed charges",94.47,75,,75.58,,,0,"percent of total billed charges","75% of total billed charges",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.69,72,,72.55,,,0,"percent of total billed charges","72% of total billed charges",75.58,60,,60.46,,,0,"percent of total billed charges","60% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",56.68,45,,45.34,,,0,"percent of total billed charges","45% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.96,100,,,,,0,"fee schedule","100% CMS fee schedule",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",81.87,65,,65.50,,,0,"percent of total billed charges","65% of total billed charges",55.55,27,,44.44,,,0,"percent of total billed charges","27% of total billed charges",119.66,95,,95.73,,,0,"percent of total billed charges","95% of total billed charges",125.96,75,,,,,0,"fee schedule","75% of CMS fee schedule",110.84,88,,88.67,,,0,"percent of total billed charges","88% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",55.55,125.96,
"TETRACAINE 0.5% OPHTH SOL 15ML",2500000187,CDM,250,RC,,,Outpatient,,,125.96,62.98,,125.96,125,,,,,0,"fee schedule","125% of CMS fee schedule",95.73,76,,76.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",90.69,72,,72.55,,,0,"percent of total billed charges","72% of total billed charges",94.47,75,,75.58,,,0,"percent of total billed charges","75% of total billed charges",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.69,72,,72.55,,,0,"percent of total billed charges","72% of total billed charges",75.58,60,,60.46,,,0,"percent of total billed charges","60% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",56.68,45,,45.34,,,0,"percent of total billed charges","45% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.96,100,,,,,0,"fee schedule","100% CMS fee schedule",125.96,100,,,,,0,"fee schedule","100% of CMS fee schedule",81.87,65,,65.50,,,0,"percent of total billed charges","65% of total billed charges",55.55,27,,44.44,,,0,"percent of total billed charges","27% of total billed charges",119.66,95,,95.73,,,0,"percent of total billed charges","95% of total billed charges",125.96,75,,,,,0,"fee schedule","75% of CMS fee schedule",110.84,88,,88.67,,,0,"percent of total billed charges","88% of total billed charges",113.36,90,,90.69,,,0,"percent of total billed charges","90% of total billed charges",55.55,125.96,
"XYLOC MPF 2% 10MLW/EPI INJ10ML",2500000202,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"XYLOC MPF 2% 10MLW/EPI INJ10ML",2500000203,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"MAXIPIME 2 GRAM VIAL INJ",2500000210,CDM,250,RC,J0692,HCPCS,Outpatient,,,109.15,54.575,U8,109.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.95,76,,30.40,30.40,30.40,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.58,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",8.58,350,,,,,0,"fee schedule","350% of BCBS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.58,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.45,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",49.12,45,,39.30,,,0,"percent of total billed charges","45% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.95,65,,56.76,,,0,"percent of total billed charges","65% of total billed charges",48.14,27,,5.02,3.65,6.39,"1 through 10","percent of total billed charges","27% of total billed charges",103.69,95,,82.95,,,0,"percent of total billed charges","95% of total billed charges",109.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",96.05,88,,76.84,,,0,"percent of total billed charges","88% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",2.45,109.15,
"MAXIPIME 2 GRAM VIAL INJ",2500000211,CDM,250,RC,J0692,HCPCS,Outpatient,,,109.15,54.575,U8,109.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.95,76,,30.40,30.40,30.40,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.58,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",8.58,350,,,,,0,"fee schedule","350% of BCBS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.58,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.45,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",49.12,45,,39.30,,,0,"percent of total billed charges","45% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.95,65,,56.76,,,0,"percent of total billed charges","65% of total billed charges",48.14,27,,5.02,3.65,6.39,"1 through 10","percent of total billed charges","27% of total billed charges",103.69,95,,82.95,,,0,"percent of total billed charges","95% of total billed charges",109.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",96.05,88,,76.84,,,0,"percent of total billed charges","88% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",2.45,109.15,
"DIPHENYDRAMINE 50MG/ML VIAL",2500000214,CDM,250,RC,J1200,HCPCS,Outpatient,,,12.5,6.25,U8,12.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.5,76,,9.12,9.12,9.12,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.91,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",2.91,350,,,,,0,"fee schedule","350% of BCBS fee schedule",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.91,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.83,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",11.25,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",5.63,45,,4.50,,,0,"percent of total billed charges","45% of total billed charges",11.25,90,,9.00,,,0,"percent of total billed charges","90% of total billed charges",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.5,100,,,,,0,"fee schedule","100% CMS fee schedule",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.13,65,,6.50,,,0,"percent of total billed charges","65% of total billed charges",5.51,27,,6.72,4.89,12.31,33,"percent of total billed charges","27% of total billed charges",11.88,95,,9.50,,,0,"percent of total billed charges","95% of total billed charges",12.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",11,88,,8.98,8.44,10.25,"1 through 10","percent of total billed charges","88% of total billed charges",11.25,90,,9.00,,,0,"percent of total billed charges","90% of total billed charges",0.83,12.5,
"DIPHENYDRAMINE 50MG/ML VIAL",2500000215,CDM,250,RC,J1200,HCPCS,Outpatient,,,12.5,6.25,U8,12.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.5,76,,9.12,9.12,9.12,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.91,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",2.91,350,,,,,0,"fee schedule","350% of BCBS fee schedule",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.91,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.83,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",11.25,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",5.63,45,,4.50,,,0,"percent of total billed charges","45% of total billed charges",11.25,90,,9.00,,,0,"percent of total billed charges","90% of total billed charges",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.5,100,,,,,0,"fee schedule","100% CMS fee schedule",12.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.13,65,,6.50,,,0,"percent of total billed charges","65% of total billed charges",5.51,27,,6.72,4.89,12.31,33,"percent of total billed charges","27% of total billed charges",11.88,95,,9.50,,,0,"percent of total billed charges","95% of total billed charges",12.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",11,88,,8.98,8.44,10.25,"1 through 10","percent of total billed charges","88% of total billed charges",11.25,90,,9.00,,,0,"percent of total billed charges","90% of total billed charges",0.83,12.5,
"HEPARIN DRIP 25 000/250ML INJ",2500000222,CDM,250,RC,J1644,HCPCS,Outpatient,,,57.33,28.665,U8,57.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",43.57,76,,34.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.8,45,,20.64,,,0,"percent of total billed charges","45% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.26,65,,29.81,,,0,"percent of total billed charges","65% of total billed charges",25.28,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",54.46,95,,43.57,,,0,"percent of total billed charges","95% of total billed charges",57.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",50.45,88,,40.36,,,0,"percent of total billed charges","88% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",0.19,57.33,
"HEPARIN DRIP 25 000/250ML INJ",2500000223,CDM,250,RC,J1644,HCPCS,Outpatient,,,57.33,28.665,U8,57.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",43.57,76,,34.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.8,45,,20.64,,,0,"percent of total billed charges","45% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.26,65,,29.81,,,0,"percent of total billed charges","65% of total billed charges",25.28,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",54.46,95,,43.57,,,0,"percent of total billed charges","95% of total billed charges",57.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",50.45,88,,40.36,,,0,"percent of total billed charges","88% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",0.19,57.33,
"HEPARIN SOD 1000UN INJ",2500000226,CDM,250,RC,J1644,HCPCS,Outpatient,,,17.42,8.71,U8,17.42,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.24,76,,10.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",17.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",15.68,90,,12.54,,,0,"percent of total billed charges","90% of total billed charges",7.84,45,,6.27,,,0,"percent of total billed charges","45% of total billed charges",15.68,90,,12.54,,,0,"percent of total billed charges","90% of total billed charges",17.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.42,100,,,,,0,"fee schedule","100% CMS fee schedule",17.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.32,65,,9.06,,,0,"percent of total billed charges","65% of total billed charges",7.68,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",16.55,95,,13.24,,,0,"percent of total billed charges","95% of total billed charges",17.42,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.33,88,,12.26,,,0,"percent of total billed charges","88% of total billed charges",15.68,90,,12.54,,,0,"percent of total billed charges","90% of total billed charges",0.19,17.42,
"HEPARIN SOD 1000UN INJ",2500000227,CDM,250,RC,J1644,HCPCS,Outpatient,,,25.36,12.68,U8,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",0.19,25.36,
"HEPARIN 5000UN INJ",2500000230,CDM,250,RC,J1644,HCPCS,Outpatient,,,25.36,12.68,U8,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",0.19,25.36,
"HEPARIN 5000UN INJ",2500000231,CDM,250,RC,J1644,HCPCS,Outpatient,,,25.36,12.68,U8,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",0.19,25.36,
"LEVOFLOXACIN 500MG/100ML INJ",2500000242,CDM,250,RC,J1956,HCPCS,Outpatient,,,253.58,126.79,U8,253.58,125,,,,,0,"fee schedule","125% of CMS fee schedule",192.72,76,,154.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.02,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",6.02,350,,,,,0,"fee schedule","350% of BCBS fee schedule",253.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.02,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.72,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",228.22,90,,182.58,,,0,"percent of total billed charges","90% of total billed charges",114.11,45,,91.29,,,0,"percent of total billed charges","45% of total billed charges",228.22,90,,182.58,,,0,"percent of total billed charges","90% of total billed charges",253.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",253.58,100,,,,,0,"fee schedule","100% CMS fee schedule",253.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.83,65,,131.86,,,0,"percent of total billed charges","65% of total billed charges",111.83,27,,3.73,3.11,49.61,"1 through 10","percent of total billed charges","27% of total billed charges",240.9,95,,192.72,,,0,"percent of total billed charges","95% of total billed charges",253.58,75,,,,,0,"fee schedule","75% of CMS fee schedule",223.15,88,,178.52,,,0,"percent of total billed charges","88% of total billed charges",228.22,90,,182.58,,,0,"percent of total billed charges","90% of total billed charges",1.72,253.58,
"LEVOFLOXACIN 500MG/100ML INJ",2500000243,CDM,250,RC,J1956,HCPCS,Outpatient,,,23.5,11.75,U8,23.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.86,76,,14.29,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.02,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",6.02,350,,,,,0,"fee schedule","350% of BCBS fee schedule",23.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.02,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.72,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",21.15,90,,16.92,,,0,"percent of total billed charges","90% of total billed charges",10.58,45,,8.46,,,0,"percent of total billed charges","45% of total billed charges",21.15,90,,16.92,,,0,"percent of total billed charges","90% of total billed charges",23.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.5,100,,,,,0,"fee schedule","100% CMS fee schedule",23.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.28,65,,12.22,,,0,"percent of total billed charges","65% of total billed charges",10.36,27,,3.73,3.11,49.61,"1 through 10","percent of total billed charges","27% of total billed charges",22.33,95,,17.86,,,0,"percent of total billed charges","95% of total billed charges",23.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.68,88,,16.54,,,0,"percent of total billed charges","88% of total billed charges",21.15,90,,16.92,,,0,"percent of total billed charges","90% of total billed charges",1.72,23.5,
"LIDOCAINE HCL 2% 10 ML INJ",2500000246,CDM,250,RC,J2003,HCPCS,Outpatient,,,12,6,U8,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",10.56,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"LIDOCAINE HCL 2% 10 ML INJ",2500000247,CDM,250,RC,J2003,HCPCS,Outpatient,,,12,6,U8,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",10.56,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"ATIVAN 2MG/ML INJ",2500000250,CDM,250,RC,J2060,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.12,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",1.12,350,,,,,0,"fee schedule","350% of BCBS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.12,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.32,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,6.41,4.89,17.67,18,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,8.45,4.34,9.29,"1 through 10","percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.32,11.03,
"ATIVAN 2MG/ML INJ",2500000251,CDM,250,RC,J2060,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.12,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",1.12,350,,,,,0,"fee schedule","350% of BCBS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.12,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.32,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,6.41,4.89,17.67,18,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,8.45,4.34,9.29,"1 through 10","percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.32,11.03,
"DEMEROL 25MG INJ SLI INJ",2500000254,CDM,250,RC,J2175,HCPCS,Outpatient,,,12,6,U8,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",0.94,12,
"DEMEROL 25MG INJ SLI INJ",2500000255,CDM,250,RC,J2175,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.94,11.03,
"DEMEROL 50MG INJ SLI INJ",2500000258,CDM,250,RC,J2175,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.94,11.03,
"DEMEROL 50MG INJ SLI INJ",2500000259,CDM,250,RC,J2175,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.94,11.03,
"DEMEROL 100MG INJ",2500000262,CDM,250,RC,J2175,HCPCS,Outpatient,,,16,8,U8,16,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.16,76,,9.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",7.2,45,,5.76,,,0,"percent of total billed charges","45% of total billed charges",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,100,,,,,0,"fee schedule","100% CMS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.4,65,,8.32,,,0,"percent of total billed charges","65% of total billed charges",7.06,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",15.2,95,,12.16,,,0,"percent of total billed charges","95% of total billed charges",16,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.08,88,,11.26,,,0,"percent of total billed charges","88% of total billed charges",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",0.94,16,
"DEMEROL 100MG INJ",2500000263,CDM,250,RC,J2175,HCPCS,Outpatient,,,16,8,U8,16,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.16,76,,9.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.94,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",7.2,45,,5.76,,,0,"percent of total billed charges","45% of total billed charges",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",16,100,,,,,0,"fee schedule","100% CMS fee schedule",16,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.4,65,,8.32,,,0,"percent of total billed charges","65% of total billed charges",7.06,27,,8.60,8.60,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",15.2,95,,12.16,,,0,"percent of total billed charges","95% of total billed charges",16,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.08,88,,11.26,,,0,"percent of total billed charges","88% of total billed charges",14.4,90,,11.52,,,0,"percent of total billed charges","90% of total billed charges",0.94,16,
"MORPHINE SULFATE 2MG INJ",2500000266,CDM,250,RC,J2270,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,9.82,9.82,9.82,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,5.98,5.11,12.28,23,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,10.03,6.94,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.07,9.92,
"MORPHINE SULFATE 2MG INJ",2500000267,CDM,250,RC,J2270,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,9.82,9.82,9.82,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,5.98,5.11,12.28,23,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,10.03,6.94,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.07,9.92,
"ZOFRAN 1MG INJ",2500000270,CDM,636,RC,J2405,HCPCS,Outpatient,,,5.51,2.755,U8,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,9.12,6.30,9.12,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.07,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",2.07,350,,,,,0,"fee schedule","350% of BCBS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.07,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.59,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",4.96,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,0.12,0.09,0.26,192,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,8.45,6.29,10.56,18,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",0.59,5.51,
"ZOFRAN 1MG INJ",2500000271,CDM,636,RC,J2405,HCPCS,Outpatient,,,5.51,2.755,U8,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,9.12,6.30,9.12,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.07,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",2.07,350,,,,,0,"fee schedule","350% of BCBS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.07,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.59,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",4.96,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,0.12,0.09,0.26,192,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,8.45,6.29,10.56,18,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",0.59,5.51,
"PHENERGAN 25MG INJ",2500000274,CDM,250,RC,J2550,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.48,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",4.48,350,,,,,0,"fee schedule","350% of BCBS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.48,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.28,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,7.53,5.64,11.32,"1 through 10","percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",1.28,6.62,
"PHENERGAN 25MG INJ",2500000275,CDM,250,RC,J2550,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.48,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",4.48,350,,,,,0,"fee schedule","350% of BCBS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.48,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.28,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,7.53,5.64,11.32,"1 through 10","percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",1.28,6.62,
"ULORIC 40MG TAB",2500000278,CDM,250,RC,J3490,HCPCS,Outpatient,,,25.36,12.68,U8,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"ULORIC 40MG TAB",2500000279,CDM,250,RC,J3490,HCPCS,Outpatient,,,25.36,12.68,U8,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"KETAMINE 500MG/10ML INJ",2500000282,CDM,250,RC,J3490,HCPCS,Outpatient,,,25.5,12.75,U8,25.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.38,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.36,72,,14.69,,,0,"percent of total billed charges","72% of total billed charges",19.13,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.36,72,,14.69,,,0,"percent of total billed charges","72% of total billed charges",15.3,60,,12.24,,,0,"percent of total billed charges","60% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",11.48,45,,9.18,,,0,"percent of total billed charges","45% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.5,100,,,,,0,"fee schedule","100% CMS fee schedule",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.58,65,,13.26,,,0,"percent of total billed charges","65% of total billed charges",11.25,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",24.23,95,,19.38,,,0,"percent of total billed charges","95% of total billed charges",25.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.44,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",11.25,25.5,
"KETAMINE 500MG/10ML INJ",2500000283,CDM,250,RC,J3490,HCPCS,Outpatient,,,25.5,12.75,TB,25.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.38,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.36,72,,14.69,,,0,"percent of total billed charges","72% of total billed charges",19.13,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.36,72,,14.69,,,0,"percent of total billed charges","72% of total billed charges",15.3,60,,12.24,,,0,"percent of total billed charges","60% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",11.48,45,,9.18,,,0,"percent of total billed charges","45% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.5,100,,,,,0,"fee schedule","100% CMS fee schedule",25.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.58,65,,13.26,,,0,"percent of total billed charges","65% of total billed charges",11.25,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",24.23,95,,19.38,,,0,"percent of total billed charges","95% of total billed charges",25.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.44,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",22.95,90,,18.36,,,0,"percent of total billed charges","90% of total billed charges",11.25,25.5,
"ROBINUL 0.2MG/ML INJ",2500000286,CDM,250,RC,J3490,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"ROBINUL 0.2MG/ML INJ",2500000287,CDM,250,RC,J1596,HCPCS,Outpatient,,,9.92,4.96,TB,0.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.56,100,,1.43,1.43,1.43,"1 through 10","fee schedule","100% of CMS OPPS rate",1.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.37,27,,8.67,8.67,8.67,"1 through 10","percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",0.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",0.43,9.42,
"ROCURONIUM 100MG/10ML INJ",2500000290,CDM,250,RC,J3490,HCPCS,Outpatient,,,222.71,111.355,U8,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"ROCURONIUM 100MG/10ML INJ",2500000291,CDM,250,RC,J3490,HCPCS,Outpatient,,,222.71,111.355,U8,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"PEPCID INJ 20MG/2ML INJ",2500000294,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"PEPCID INJ 20MG/2ML INJ",2500000295,CDM,250,RC,J1308,HCPCS,Outpatient,,,12,6,TB,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"ROCURONIUM 50MG/5ML VIAL",2500000298,CDM,250,RC,J3490,HCPCS,Outpatient,,,115.76,57.88,U8,115.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.98,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",86.82,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",69.46,60,,55.57,,,0,"percent of total billed charges","60% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",52.09,45,,41.67,,,0,"percent of total billed charges","45% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",75.24,65,,60.19,,,0,"percent of total billed charges","65% of total billed charges",51.05,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",109.97,95,,87.98,,,0,"percent of total billed charges","95% of total billed charges",115.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",101.87,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",51.05,115.76,
"ROCURONIUM 50MG/5ML VIAL",2500000299,CDM,250,RC,J3490,HCPCS,Outpatient,,,115.76,57.88,U8,115.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.98,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",86.82,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",69.46,60,,55.57,,,0,"percent of total billed charges","60% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",52.09,45,,41.67,,,0,"percent of total billed charges","45% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",75.24,65,,60.19,,,0,"percent of total billed charges","65% of total billed charges",51.05,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",109.97,95,,87.98,,,0,"percent of total billed charges","95% of total billed charges",115.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",101.87,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",51.05,115.76,
"CEFOTETAN 2 G INJ",2500000310,CDM,250,RC,J3490,HCPCS,Outpatient,,,152,76,U8,152,125,,,,,0,"fee schedule","125% of CMS fee schedule",115.52,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",109.44,72,,87.55,,,0,"percent of total billed charges","72% of total billed charges",114,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.44,72,,87.55,,,0,"percent of total billed charges","72% of total billed charges",91.2,60,,72.96,,,0,"percent of total billed charges","60% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",68.4,45,,54.72,,,0,"percent of total billed charges","45% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",152,100,,,,,0,"fee schedule","100% CMS fee schedule",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.8,65,,79.04,,,0,"percent of total billed charges","65% of total billed charges",67.03,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",144.4,95,,115.52,,,0,"percent of total billed charges","95% of total billed charges",152,75,,,,,0,"fee schedule","75% of CMS fee schedule",133.76,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",67.03,152,
"CEFOTETAN 2 G INJ",2500000311,CDM,250,RC,J3490,HCPCS,Outpatient,,,152,76,U8,152,125,,,,,0,"fee schedule","125% of CMS fee schedule",115.52,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",109.44,72,,87.55,,,0,"percent of total billed charges","72% of total billed charges",114,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.44,72,,87.55,,,0,"percent of total billed charges","72% of total billed charges",91.2,60,,72.96,,,0,"percent of total billed charges","60% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",68.4,45,,54.72,,,0,"percent of total billed charges","45% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",152,100,,,,,0,"fee schedule","100% CMS fee schedule",152,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.8,65,,79.04,,,0,"percent of total billed charges","65% of total billed charges",67.03,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",144.4,95,,115.52,,,0,"percent of total billed charges","95% of total billed charges",152,75,,,,,0,"fee schedule","75% of CMS fee schedule",133.76,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",136.8,90,,109.44,,,0,"percent of total billed charges","90% of total billed charges",67.03,152,
"LABETALOL INJ 5MG/ML INJ 40ML",2500000314,CDM,250,RC,J3490,HCPCS,Outpatient,,,98.75,49.375,U8,98.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.05,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.1,72,,56.88,,,0,"percent of total billed charges","72% of total billed charges",74.06,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.1,72,,56.88,,,0,"percent of total billed charges","72% of total billed charges",59.25,60,,47.40,,,0,"percent of total billed charges","60% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",44.44,45,,35.55,,,0,"percent of total billed charges","45% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.75,100,,,,,0,"fee schedule","100% CMS fee schedule",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.19,65,,51.35,,,0,"percent of total billed charges","65% of total billed charges",43.55,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",93.81,95,,75.05,,,0,"percent of total billed charges","95% of total billed charges",98.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",86.9,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",43.55,98.75,
"LABETALOL INJ 5MG/ML INJ 40ML",2500000315,CDM,250,RC,J3490,HCPCS,Outpatient,,,98.75,49.375,U8,98.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.05,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.1,72,,56.88,,,0,"percent of total billed charges","72% of total billed charges",74.06,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.1,72,,56.88,,,0,"percent of total billed charges","72% of total billed charges",59.25,60,,47.40,,,0,"percent of total billed charges","60% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",44.44,45,,35.55,,,0,"percent of total billed charges","45% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.75,100,,,,,0,"fee schedule","100% CMS fee schedule",98.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.19,65,,51.35,,,0,"percent of total billed charges","65% of total billed charges",43.55,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",93.81,95,,75.05,,,0,"percent of total billed charges","95% of total billed charges",98.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",86.9,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",88.88,90,,71.10,,,0,"percent of total billed charges","90% of total billed charges",43.55,98.75,
"XOPENEX HFA 45MCG",2500000318,CDM,250,RC,J3535,HCPCS,Outpatient,,,256,128,U8,256,125,,,,,0,"fee schedule","125% of CMS fee schedule",194.56,76,,155.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",184.32,72,,147.46,,,0,"percent of total billed charges","72% of total billed charges",192,75,,153.60,,,0,"percent of total billed charges","75% of total billed charges",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",184.32,72,,147.46,,,0,"percent of total billed charges","72% of total billed charges",153.6,60,,122.88,,,0,"percent of total billed charges","60% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",115.2,45,,92.16,,,0,"percent of total billed charges","45% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",256,100,,,,,0,"fee schedule","100% CMS fee schedule",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",166.4,65,,133.12,,,0,"percent of total billed charges","65% of total billed charges",112.9,27,,90.32,,,0,"percent of total billed charges","27% of total billed charges",243.2,95,,194.56,,,0,"percent of total billed charges","95% of total billed charges",256,75,,,,,0,"fee schedule","75% of CMS fee schedule",225.28,88,,180.22,,,0,"percent of total billed charges","88% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",112.9,256,
"XOPENEX HFA 45MCG",2500000319,CDM,250,RC,J3535,HCPCS,Outpatient,,,256,128,U8,256,125,,,,,0,"fee schedule","125% of CMS fee schedule",194.56,76,,155.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",184.32,72,,147.46,,,0,"percent of total billed charges","72% of total billed charges",192,75,,153.60,,,0,"percent of total billed charges","75% of total billed charges",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",184.32,72,,147.46,,,0,"percent of total billed charges","72% of total billed charges",153.6,60,,122.88,,,0,"percent of total billed charges","60% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",115.2,45,,92.16,,,0,"percent of total billed charges","45% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",256,100,,,,,0,"fee schedule","100% CMS fee schedule",256,100,,,,,0,"fee schedule","100% of CMS fee schedule",166.4,65,,133.12,,,0,"percent of total billed charges","65% of total billed charges",112.9,27,,90.32,,,0,"percent of total billed charges","27% of total billed charges",243.2,95,,194.56,,,0,"percent of total billed charges","95% of total billed charges",256,75,,,,,0,"fee schedule","75% of CMS fee schedule",225.28,88,,180.22,,,0,"percent of total billed charges","88% of total billed charges",230.4,90,,184.32,,,0,"percent of total billed charges","90% of total billed charges",112.9,256,
"250CC D5W IV",2500000322,CDM,250,RC,J7060,HCPCS,Outpatient,,,52.92,26.46,U8,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.41,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",25.41,350,,,,,0,"fee schedule","350% of BCBS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.41,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",7.26,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,2.47,2.47,2.47,"1 through 10","percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,41.36,41.36,41.36,"1 through 10","percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",7.26,52.92,
"250CC D5W IV",2500000323,CDM,250,RC,J7060,HCPCS,Outpatient,,,52.92,26.46,U8,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.41,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",25.41,350,,,,,0,"fee schedule","350% of BCBS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.41,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",7.26,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,2.47,2.47,2.47,"1 through 10","percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,41.36,41.36,41.36,"1 through 10","percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",7.26,52.92,
"ACETYLCYSTEINE 20% 4ML",2500000326,CDM,250,RC,J7608,HCPCS,Outpatient,,,48,24,U8,48,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.48,76,,29.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.7,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",14.7,350,,,,,0,"fee schedule","350% of BCBS fee schedule",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",4.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",21.6,45,,17.28,,,0,"percent of total billed charges","45% of total billed charges",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",48,100,,,,,0,"fee schedule","100% CMS fee schedule",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.2,65,,24.96,,,0,"percent of total billed charges","65% of total billed charges",21.17,27,,16.94,,,0,"percent of total billed charges","27% of total billed charges",45.6,95,,36.48,,,0,"percent of total billed charges","95% of total billed charges",48,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.24,88,,33.79,,,0,"percent of total billed charges","88% of total billed charges",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",4.2,48,
"ACETYLCYSTEINE 20% 4ML",2500000327,CDM,250,RC,J7608,HCPCS,Outpatient,,,48,24,U8,48,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.48,76,,29.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.7,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",14.7,350,,,,,0,"fee schedule","350% of BCBS fee schedule",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.7,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",4.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",21.6,45,,17.28,,,0,"percent of total billed charges","45% of total billed charges",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",48,100,,,,,0,"fee schedule","100% CMS fee schedule",48,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.2,65,,24.96,,,0,"percent of total billed charges","65% of total billed charges",21.17,27,,16.94,,,0,"percent of total billed charges","27% of total billed charges",45.6,95,,36.48,,,0,"percent of total billed charges","95% of total billed charges",48,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.24,88,,33.79,,,0,"percent of total billed charges","88% of total billed charges",43.2,90,,34.56,,,0,"percent of total billed charges","90% of total billed charges",4.2,48,
"BLEOMYCIN 30 UNIT INJ",2500000330,CDM,250,RC,J9040,HCPCS,Outpatient,,,490.61,245.305,U8,490.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",372.86,76,,298.29,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",111.58,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",111.58,350,,,,,0,"fee schedule","350% of BCBS fee schedule",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",111.58,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",31.88,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",220.77,45,,176.62,,,0,"percent of total billed charges","45% of total billed charges",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",490.61,100,,,,,0,"fee schedule","100% CMS fee schedule",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",318.9,65,,255.12,,,0,"percent of total billed charges","65% of total billed charges",216.36,27,,173.09,,,0,"percent of total billed charges","27% of total billed charges",466.08,95,,372.86,,,0,"percent of total billed charges","95% of total billed charges",490.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",431.74,88,,345.39,,,0,"percent of total billed charges","88% of total billed charges",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",31.88,490.61,
"BLEOMYCIN 30 UNIT INJ",2500000331,CDM,250,RC,J9040,HCPCS,Outpatient,,,490.61,245.305,U8,490.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",372.86,76,,298.29,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",111.58,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",111.58,350,,,,,0,"fee schedule","350% of BCBS fee schedule",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",111.58,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",31.88,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",220.77,45,,176.62,,,0,"percent of total billed charges","45% of total billed charges",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",490.61,100,,,,,0,"fee schedule","100% CMS fee schedule",490.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",318.9,65,,255.12,,,0,"percent of total billed charges","65% of total billed charges",216.36,27,,173.09,,,0,"percent of total billed charges","27% of total billed charges",466.08,95,,372.86,,,0,"percent of total billed charges","95% of total billed charges",490.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",431.74,88,,345.39,,,0,"percent of total billed charges","88% of total billed charges",441.55,90,,353.24,,,0,"percent of total billed charges","90% of total billed charges",31.88,490.61,
"GEOCILLIN 500 MG TAB",2500000350,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"GEOCILLIN 500 MG TAB",2500000351,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"NOVOLOG 70/30 INSULIN INJ",2500000354,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"NOVOLOG 70/30 INSULIN INJ",2500000355,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HYDASE 150 UNITS/ML INJ",2500000362,CDM,250,RC,,,Outpatient,,,135.61,67.805,,135.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",103.06,76,,82.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",97.64,72,,78.11,,,0,"percent of total billed charges","72% of total billed charges",101.71,75,,81.37,,,0,"percent of total billed charges","75% of total billed charges",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.64,72,,78.11,,,0,"percent of total billed charges","72% of total billed charges",81.37,60,,65.10,,,0,"percent of total billed charges","60% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",61.02,45,,48.82,,,0,"percent of total billed charges","45% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",135.61,100,,,,,0,"fee schedule","100% CMS fee schedule",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.15,65,,70.52,,,0,"percent of total billed charges","65% of total billed charges",59.8,27,,47.84,,,0,"percent of total billed charges","27% of total billed charges",128.83,95,,103.06,,,0,"percent of total billed charges","95% of total billed charges",135.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",119.34,88,,95.47,,,0,"percent of total billed charges","88% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",59.8,135.61,
"HYDASE 150 UNITS/ML INJ",2500000363,CDM,250,RC,,,Outpatient,,,135.61,67.805,,135.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",103.06,76,,82.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",97.64,72,,78.11,,,0,"percent of total billed charges","72% of total billed charges",101.71,75,,81.37,,,0,"percent of total billed charges","75% of total billed charges",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.64,72,,78.11,,,0,"percent of total billed charges","72% of total billed charges",81.37,60,,65.10,,,0,"percent of total billed charges","60% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",61.02,45,,48.82,,,0,"percent of total billed charges","45% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",135.61,100,,,,,0,"fee schedule","100% CMS fee schedule",135.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.15,65,,70.52,,,0,"percent of total billed charges","65% of total billed charges",59.8,27,,47.84,,,0,"percent of total billed charges","27% of total billed charges",128.83,95,,103.06,,,0,"percent of total billed charges","95% of total billed charges",135.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",119.34,88,,95.47,,,0,"percent of total billed charges","88% of total billed charges",122.05,90,,97.64,,,0,"percent of total billed charges","90% of total billed charges",59.8,135.61,
"LEVEMIR INSULIN 1CC INJ",2500000366,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LEVEMIR INSULIN 1CC INJ",2500000367,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PLAIN SHUGARCANIE MIX INJ",2500000370,CDM,250,RC,,,Outpatient,,,264.6,132.3,,264.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.1,76,,160.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",198.45,75,,158.76,,,0,"percent of total billed charges","75% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",158.76,60,,127.01,,,0,"percent of total billed charges","60% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",119.07,45,,95.26,,,0,"percent of total billed charges","45% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,65,,137.59,,,0,"percent of total billed charges","65% of total billed charges",116.69,27,,93.35,,,0,"percent of total billed charges","27% of total billed charges",251.37,95,,201.10,,,0,"percent of total billed charges","95% of total billed charges",264.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",232.85,88,,186.28,,,0,"percent of total billed charges","88% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",116.69,264.6,
"PLAIN SHUGARCANIE MIX INJ",2500000371,CDM,250,RC,,,Outpatient,,,264.6,132.3,,264.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.1,76,,160.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",198.45,75,,158.76,,,0,"percent of total billed charges","75% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",158.76,60,,127.01,,,0,"percent of total billed charges","60% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",119.07,45,,95.26,,,0,"percent of total billed charges","45% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,65,,137.59,,,0,"percent of total billed charges","65% of total billed charges",116.69,27,,93.35,,,0,"percent of total billed charges","27% of total billed charges",251.37,95,,201.10,,,0,"percent of total billed charges","95% of total billed charges",264.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",232.85,88,,186.28,,,0,"percent of total billed charges","88% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",116.69,264.6,
"XOPENEX 0.63MG/3ML NEB",2500000374,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.79,20.395,U8,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",1.48,40.79,
"XOPENEX 0.63MG/3ML NEB",2500000375,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.79,20.395,U8,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",1.48,40.79,
"GLYCINE 1.5PCT 300ML SOLN",2500000378,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"GLYCINE 1.5PCT 300ML SOLN",2500000379,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"ZITHROMAX 250MG CAP",2500000382,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"ZITHROMAX 250MG CAP",2500000383,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"DITROPAN XL 5MG TAB",2500000386,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"DITROPAN XL 5MG TAB",2500000387,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"CELEBREX 100MG CAP",2500000390,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"CELEBREX 100MG CAP",2500000391,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"AUGMENTIN 875/125MG TAB",2500000394,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"AUGMENTIN 875/125MG TAB",2500000395,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"DEPAKOTE 500 EC TAB",2500000398,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"DEPAKOTE 500 EC TAB",2500000399,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"MS CONTIN 15MG TAB",2500000402,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MS CONTIN 15MG TAB",2500000403,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PREMARIN 0.625MG CREAM",2500000406,CDM,250,RC,,,Outpatient,,,703.4,351.7,,703.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",534.58,76,,427.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",506.45,72,,405.16,,,0,"percent of total billed charges","72% of total billed charges",527.55,75,,422.04,,,0,"percent of total billed charges","75% of total billed charges",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.45,72,,405.16,,,0,"percent of total billed charges","72% of total billed charges",422.04,60,,337.63,,,0,"percent of total billed charges","60% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",316.53,45,,253.22,,,0,"percent of total billed charges","45% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",703.4,100,,,,,0,"fee schedule","100% CMS fee schedule",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",457.21,65,,365.77,,,0,"percent of total billed charges","65% of total billed charges",310.2,27,,248.16,,,0,"percent of total billed charges","27% of total billed charges",668.23,95,,534.58,,,0,"percent of total billed charges","95% of total billed charges",703.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",618.99,88,,495.19,,,0,"percent of total billed charges","88% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",310.2,703.4,
"PREMARIN 0.625MG CREAM",2500000407,CDM,250,RC,,,Outpatient,,,703.4,351.7,,703.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",534.58,76,,427.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",506.45,72,,405.16,,,0,"percent of total billed charges","72% of total billed charges",527.55,75,,422.04,,,0,"percent of total billed charges","75% of total billed charges",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.45,72,,405.16,,,0,"percent of total billed charges","72% of total billed charges",422.04,60,,337.63,,,0,"percent of total billed charges","60% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",316.53,45,,253.22,,,0,"percent of total billed charges","45% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",703.4,100,,,,,0,"fee schedule","100% CMS fee schedule",703.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",457.21,65,,365.77,,,0,"percent of total billed charges","65% of total billed charges",310.2,27,,248.16,,,0,"percent of total billed charges","27% of total billed charges",668.23,95,,534.58,,,0,"percent of total billed charges","95% of total billed charges",703.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",618.99,88,,495.19,,,0,"percent of total billed charges","88% of total billed charges",633.06,90,,506.45,,,0,"percent of total billed charges","90% of total billed charges",310.2,703.4,
"SINEMET CR 25/100 TAB",2500000410,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"SINEMET CR 25/100 TAB",2500000411,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"BECLOMETHA 84MCG INHALER",2500000414,CDM,250,RC,,,Outpatient,,,506.05,253.025,,506.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",384.6,76,,307.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",364.36,72,,291.49,,,0,"percent of total billed charges","72% of total billed charges",379.54,75,,303.63,,,0,"percent of total billed charges","75% of total billed charges",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",364.36,72,,291.49,,,0,"percent of total billed charges","72% of total billed charges",303.63,60,,242.90,,,0,"percent of total billed charges","60% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",227.72,45,,182.18,,,0,"percent of total billed charges","45% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.05,100,,,,,0,"fee schedule","100% CMS fee schedule",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",328.93,65,,263.14,,,0,"percent of total billed charges","65% of total billed charges",223.17,27,,178.54,,,0,"percent of total billed charges","27% of total billed charges",480.75,95,,384.60,,,0,"percent of total billed charges","95% of total billed charges",506.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",445.32,88,,356.26,,,0,"percent of total billed charges","88% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",223.17,506.05,
"BECLOMETHA 84MCG INHALER",2500000415,CDM,250,RC,,,Outpatient,,,506.05,253.025,,506.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",384.6,76,,307.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",364.36,72,,291.49,,,0,"percent of total billed charges","72% of total billed charges",379.54,75,,303.63,,,0,"percent of total billed charges","75% of total billed charges",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",364.36,72,,291.49,,,0,"percent of total billed charges","72% of total billed charges",303.63,60,,242.90,,,0,"percent of total billed charges","60% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",227.72,45,,182.18,,,0,"percent of total billed charges","45% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.05,100,,,,,0,"fee schedule","100% CMS fee schedule",506.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",328.93,65,,263.14,,,0,"percent of total billed charges","65% of total billed charges",223.17,27,,178.54,,,0,"percent of total billed charges","27% of total billed charges",480.75,95,,384.60,,,0,"percent of total billed charges","95% of total billed charges",506.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",445.32,88,,356.26,,,0,"percent of total billed charges","88% of total billed charges",455.45,90,,364.36,,,0,"percent of total billed charges","90% of total billed charges",223.17,506.05,
"VICOPROFEN TAB",2500000418,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"VICOPROFEN TAB",2500000419,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ZYBAN 150MG TAB",2500000422,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ZYBAN 150MG TAB",2500000423,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"TOPROL XL 25MG TAB",2500000426,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TOPROL XL 25MG TAB",2500000427,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"QVAR 40MCG INHALER",2500000430,CDM,250,RC,,,Outpatient,,,378.16,189.08,,378.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",287.4,76,,229.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",272.28,72,,217.82,,,0,"percent of total billed charges","72% of total billed charges",283.62,75,,226.90,,,0,"percent of total billed charges","75% of total billed charges",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",272.28,72,,217.82,,,0,"percent of total billed charges","72% of total billed charges",226.9,60,,181.52,,,0,"percent of total billed charges","60% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",170.17,45,,136.14,,,0,"percent of total billed charges","45% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",378.16,100,,,,,0,"fee schedule","100% CMS fee schedule",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",245.8,65,,196.64,,,0,"percent of total billed charges","65% of total billed charges",166.77,27,,133.42,,,0,"percent of total billed charges","27% of total billed charges",359.25,95,,287.40,,,0,"percent of total billed charges","95% of total billed charges",378.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",332.78,88,,266.22,,,0,"percent of total billed charges","88% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",166.77,378.16,
"QVAR 40MCG INHALER",2500000431,CDM,250,RC,,,Outpatient,,,378.16,189.08,,378.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",287.4,76,,229.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",272.28,72,,217.82,,,0,"percent of total billed charges","72% of total billed charges",283.62,75,,226.90,,,0,"percent of total billed charges","75% of total billed charges",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",272.28,72,,217.82,,,0,"percent of total billed charges","72% of total billed charges",226.9,60,,181.52,,,0,"percent of total billed charges","60% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",170.17,45,,136.14,,,0,"percent of total billed charges","45% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",378.16,100,,,,,0,"fee schedule","100% CMS fee schedule",378.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",245.8,65,,196.64,,,0,"percent of total billed charges","65% of total billed charges",166.77,27,,133.42,,,0,"percent of total billed charges","27% of total billed charges",359.25,95,,287.40,,,0,"percent of total billed charges","95% of total billed charges",378.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",332.78,88,,266.22,,,0,"percent of total billed charges","88% of total billed charges",340.34,90,,272.27,,,0,"percent of total billed charges","90% of total billed charges",166.77,378.16,
"CLEOCIN 75MG/5ML SYRUP",2500000434,CDM,250,RC,,,Outpatient,,,266.81,133.405,,266.81,125,,,,,0,"fee schedule","125% of CMS fee schedule",202.78,76,,162.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",200.11,75,,160.09,,,0,"percent of total billed charges","75% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",160.09,60,,128.07,,,0,"percent of total billed charges","60% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",120.06,45,,96.05,,,0,"percent of total billed charges","45% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.43,65,,138.74,,,0,"percent of total billed charges","65% of total billed charges",117.66,27,,94.13,,,0,"percent of total billed charges","27% of total billed charges",253.47,95,,202.78,,,0,"percent of total billed charges","95% of total billed charges",266.81,75,,,,,0,"fee schedule","75% of CMS fee schedule",234.79,88,,187.83,,,0,"percent of total billed charges","88% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",117.66,266.81,
"CLEOCIN 75MG/5ML SYRUP",2500000435,CDM,250,RC,,,Outpatient,,,266.81,133.405,,266.81,125,,,,,0,"fee schedule","125% of CMS fee schedule",202.78,76,,162.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",200.11,75,,160.09,,,0,"percent of total billed charges","75% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",160.09,60,,128.07,,,0,"percent of total billed charges","60% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",120.06,45,,96.05,,,0,"percent of total billed charges","45% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.43,65,,138.74,,,0,"percent of total billed charges","65% of total billed charges",117.66,27,,94.13,,,0,"percent of total billed charges","27% of total billed charges",253.47,95,,202.78,,,0,"percent of total billed charges","95% of total billed charges",266.81,75,,,,,0,"fee schedule","75% of CMS fee schedule",234.79,88,,187.83,,,0,"percent of total billed charges","88% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",117.66,266.81,
"ZITHROMAX 200MG/5ML SUSP E",2500000438,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ZITHROMAX 200MG/5ML SUSP E",2500000439,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ZITHROMAX 200MG/5ML SUSP S",2500000442,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ZITHROMAX 200MG/5ML SUSP S",2500000443,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PHENOBARBITAL 32.4 MG TAB",2500000446,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PHENOBARBITAL 32.4 MG TAB",2500000447,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PROPARACAINE 0.5% 15ML OPHTH",2500000450,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROPARACAINE 0.5% 15ML OPHTH",2500000451,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ACETAMIN 120MG SUPP",2500000454,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ACETAMIN 120MG SUPP",2500000455,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DICLOFENAC 50MG XL TAB",2500000458,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"DICLOFENAC 50MG XL TAB",2500000459,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"KEPPRA 500 MG TAB",2500000462,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"KEPPRA 500 MG TAB",2500000463,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"LOVAZA 1 GRAM CAP",2500000466,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LOVAZA 1 GRAM CAP",2500000467,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"MESALAMINE RECTAL ENEMA",2500000470,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"MESALAMINE RECTAL ENEMA",2500000471,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"LORTAB ELIXIR 7.5MG/15ML ORAL",2500000474,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"LORTAB ELIXIR 7.5MG/15ML ORAL",2500000475,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"PORSTIGMIN B 15MGTAB",2500000478,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PORSTIGMIN B 15MGTAB",2500000479,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"HALF LYTELY 2 LITER",2500000482,CDM,250,RC,,,Outpatient,,,264.6,132.3,,264.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.1,76,,160.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",198.45,75,,158.76,,,0,"percent of total billed charges","75% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",158.76,60,,127.01,,,0,"percent of total billed charges","60% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",119.07,45,,95.26,,,0,"percent of total billed charges","45% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,65,,137.59,,,0,"percent of total billed charges","65% of total billed charges",116.69,27,,93.35,,,0,"percent of total billed charges","27% of total billed charges",251.37,95,,201.10,,,0,"percent of total billed charges","95% of total billed charges",264.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",232.85,88,,186.28,,,0,"percent of total billed charges","88% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",116.69,264.6,
"HALF LYTELY 2 LITER",2500000483,CDM,250,RC,,,Outpatient,,,264.6,132.3,,264.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.1,76,,160.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",198.45,75,,158.76,,,0,"percent of total billed charges","75% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.51,72,,152.41,,,0,"percent of total billed charges","72% of total billed charges",158.76,60,,127.01,,,0,"percent of total billed charges","60% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",119.07,45,,95.26,,,0,"percent of total billed charges","45% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% CMS fee schedule",264.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,65,,137.59,,,0,"percent of total billed charges","65% of total billed charges",116.69,27,,93.35,,,0,"percent of total billed charges","27% of total billed charges",251.37,95,,201.10,,,0,"percent of total billed charges","95% of total billed charges",264.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",232.85,88,,186.28,,,0,"percent of total billed charges","88% of total billed charges",238.14,90,,190.51,,,0,"percent of total billed charges","90% of total billed charges",116.69,264.6,
"ACETAMIN 650MG SUPP",2500000486,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ACETAMIN 650MG SUPP",2500000487,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"DOXEPIN 25MG CAP",2500000490,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"DOXEPIN 25MG CAP",2500000491,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ZONISAMIDE 100MG CAP",2500000494,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ZONISAMIDE 100MG CAP",2500000495,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"VOLTAREN 75MG DR TAB",2500000498,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"VOLTAREN 75MG DR TAB",2500000499,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"QUIXIN 0.5% OPHTH SOLN",2500000502,CDM,250,RC,,,Outpatient,,,84.89,42.445,,84.89,125,,,,,0,"fee schedule","125% of CMS fee schedule",64.52,76,,51.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",63.67,75,,50.94,,,0,"percent of total billed charges","75% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",50.93,60,,40.74,,,0,"percent of total billed charges","60% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",38.2,45,,30.56,,,0,"percent of total billed charges","45% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.18,65,,44.14,,,0,"percent of total billed charges","65% of total billed charges",37.44,27,,29.95,,,0,"percent of total billed charges","27% of total billed charges",80.65,95,,64.52,,,0,"percent of total billed charges","95% of total billed charges",84.89,75,,,,,0,"fee schedule","75% of CMS fee schedule",74.7,88,,59.76,,,0,"percent of total billed charges","88% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",37.44,84.89,
"QUIXIN 0.5% OPHTH SOLN",2500000503,CDM,250,RC,,,Outpatient,,,84.89,42.445,,84.89,125,,,,,0,"fee schedule","125% of CMS fee schedule",64.52,76,,51.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",63.67,75,,50.94,,,0,"percent of total billed charges","75% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",50.93,60,,40.74,,,0,"percent of total billed charges","60% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",38.2,45,,30.56,,,0,"percent of total billed charges","45% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.18,65,,44.14,,,0,"percent of total billed charges","65% of total billed charges",37.44,27,,29.95,,,0,"percent of total billed charges","27% of total billed charges",80.65,95,,64.52,,,0,"percent of total billed charges","95% of total billed charges",84.89,75,,,,,0,"fee schedule","75% of CMS fee schedule",74.7,88,,59.76,,,0,"percent of total billed charges","88% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",37.44,84.89,
"DICOLOFENAC 0.1% OPHTH SOLN",2500000506,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"DICOLOFENAC 0.1% OPHTH SOLN",2500000507,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"VESICARE 5MG TAB",2500000510,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"VESICARE 5MG TAB",2500000511,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"FIORNAL TAB",2500000514,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"FIORNAL TAB",2500000515,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MUCINEX D 600/60 TAB",2500000518,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MUCINEX D 600/60 TAB",2500000519,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ORAPRED 15MG TAB",2500000522,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"ORAPRED 15MG TAB",2500000523,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"IMITREX 25MG TAB",2500000526,CDM,250,RC,,,Outpatient,,,103.64,51.82,,103.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",78.77,76,,63.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",77.73,75,,62.18,,,0,"percent of total billed charges","75% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",62.18,60,,49.74,,,0,"percent of total billed charges","60% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",46.64,45,,37.31,,,0,"percent of total billed charges","45% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.37,65,,53.90,,,0,"percent of total billed charges","65% of total billed charges",45.71,27,,36.57,,,0,"percent of total billed charges","27% of total billed charges",98.46,95,,78.77,,,0,"percent of total billed charges","95% of total billed charges",103.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",91.2,88,,72.96,,,0,"percent of total billed charges","88% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",45.71,103.64,
"IMITREX 25MG TAB",2500000527,CDM,250,RC,,,Outpatient,,,103.64,51.82,,103.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",78.77,76,,63.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",77.73,75,,62.18,,,0,"percent of total billed charges","75% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",62.18,60,,49.74,,,0,"percent of total billed charges","60% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",46.64,45,,37.31,,,0,"percent of total billed charges","45% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.37,65,,53.90,,,0,"percent of total billed charges","65% of total billed charges",45.71,27,,36.57,,,0,"percent of total billed charges","27% of total billed charges",98.46,95,,78.77,,,0,"percent of total billed charges","95% of total billed charges",103.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",91.2,88,,72.96,,,0,"percent of total billed charges","88% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",45.71,103.64,
"DIOVAN 160MG TAB",2500000530,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"DIOVAN 160MG TAB",2500000531,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"A&D OINTMENT TUBE",2500000534,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"A&D OINTMENT TUBE",2500000535,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"BACTRIM SUSP 60ML (S)",2500000538,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"BACTRIM SUSP 60ML (S)",2500000539,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"BACTRIM SUSP 60ML (E)",2500000542,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"BACTRIM SUSP 60ML (E)",2500000543,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"OMNICEF 300MG CAP",2500000546,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"OMNICEF 300MG CAP",2500000547,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"LYRICA 25MG CAP",2500000550,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"LYRICA 25MG CAP",2500000551,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"LYRICA 50MG CAP",2500000554,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"LYRICA 50MG CAP",2500000555,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"LANOLIN 2CC UD",2500000558,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"LANOLIN 2CC UD",2500000559,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"RENVELA 800MG TAB",2500000562,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"RENVELA 800MG TAB",2500000563,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"FOSRENOL 500MG TAB",2500000566,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"FOSRENOL 500MG TAB",2500000567,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"HECTEROL 0.5MCG CAP",2500000570,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"HECTEROL 0.5MCG CAP",2500000571,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"HECTEROL 2.5MCG CAP",2500000574,CDM,250,RC,,,Outpatient,,,99.23,49.615,,99.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.41,76,,60.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",74.42,75,,59.54,,,0,"percent of total billed charges","75% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",59.54,60,,47.63,,,0,"percent of total billed charges","60% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",44.65,45,,35.72,,,0,"percent of total billed charges","45% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.5,65,,51.60,,,0,"percent of total billed charges","65% of total billed charges",43.76,27,,35.01,,,0,"percent of total billed charges","27% of total billed charges",94.27,95,,75.42,,,0,"percent of total billed charges","95% of total billed charges",99.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",87.32,88,,69.86,,,0,"percent of total billed charges","88% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",43.76,99.23,
"HECTEROL 2.5MCG CAP",2500000575,CDM,250,RC,,,Outpatient,,,99.23,49.615,,99.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.41,76,,60.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",74.42,75,,59.54,,,0,"percent of total billed charges","75% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",59.54,60,,47.63,,,0,"percent of total billed charges","60% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",44.65,45,,35.72,,,0,"percent of total billed charges","45% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.5,65,,51.60,,,0,"percent of total billed charges","65% of total billed charges",43.76,27,,35.01,,,0,"percent of total billed charges","27% of total billed charges",94.27,95,,75.42,,,0,"percent of total billed charges","95% of total billed charges",99.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",87.32,88,,69.86,,,0,"percent of total billed charges","88% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",43.76,99.23,
"VOLTAREN 1% GEL 100G",2500000578,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"VOLTAREN 1% GEL 100G",2500000579,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AFRIN NASAL SOL 15CC",2500000582,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"AFRIN NASAL SOL 15CC",2500000583,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"ALDACTONE 25MG TAB",2500000586,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ALDACTONE 25MG TAB",2500000587,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ATARAX 25MG TAB",2500000590,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ATARAX 25MG TAB",2500000591,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ALDOMET 250MG TAB",2500000594,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ALDOMET 250MG TAB",2500000595,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ALLBEE/VIT C CAP",2500000598,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ALLBEE/VIT C CAP",2500000599,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ALPHAGAN 0.2% OPHTH SOLN",2500000602,CDM,250,RC,,,Outpatient,,,158.76,79.38,,158.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",120.66,76,,96.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",119.07,75,,95.26,,,0,"percent of total billed charges","75% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",95.26,60,,76.21,,,0,"percent of total billed charges","60% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",71.44,45,,57.15,,,0,"percent of total billed charges","45% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.19,65,,82.55,,,0,"percent of total billed charges","65% of total billed charges",70.01,27,,56.01,,,0,"percent of total billed charges","27% of total billed charges",150.82,95,,120.66,,,0,"percent of total billed charges","95% of total billed charges",158.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",139.71,88,,111.77,,,0,"percent of total billed charges","88% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",70.01,158.76,
"ALPHAGAN 0.2% OPHTH SOLN",2500000603,CDM,250,RC,,,Outpatient,,,158.76,79.38,,158.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",120.66,76,,96.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",119.07,75,,95.26,,,0,"percent of total billed charges","75% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",95.26,60,,76.21,,,0,"percent of total billed charges","60% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",71.44,45,,57.15,,,0,"percent of total billed charges","45% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.19,65,,82.55,,,0,"percent of total billed charges","65% of total billed charges",70.01,27,,56.01,,,0,"percent of total billed charges","27% of total billed charges",150.82,95,,120.66,,,0,"percent of total billed charges","95% of total billed charges",158.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",139.71,88,,111.77,,,0,"percent of total billed charges","88% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",70.01,158.76,
"AMARYL 2MG TAB",2500000606,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"AMARYL 2MG TAB",2500000607,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"HYDROCOD APAP 10/500MG TAB",2500000610,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"HYDROCOD APAP 10/500MG TAB",2500000611,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NIMOTOP 30MG CAP",2500000614,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"NIMOTOP 30MG CAP",2500000615,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"PREVACID 30MG SOLUTAB",2500000618,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"PREVACID 30MG SOLUTAB",2500000619,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"SKELAXIN 800MG TAB",2500000622,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"SKELAXIN 800MG TAB",2500000623,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"AMMONIA INHAL SNAPS",2500000626,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"AMMONIA INHAL SNAPS",2500000627,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"AMOXIL 500MG CAP",2500000630,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"AMOXIL 500MG CAP",2500000631,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"AMOXIL 250MG CAP",2500000634,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AMOXIL 250MG CAP",2500000635,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AMOXIL SUSP 125MG/5ML",2500000638,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"AMOXIL SUSP 125MG/5ML",2500000639,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"ANTIVERT 25MG TAB",2500000642,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ANTIVERT 25MG TAB",2500000643,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ANUSOL PLAIN SUPP",2500000646,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ANUSOL PLAIN SUPP",2500000647,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ANUSOL HC SUPP",2500000650,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ANUSOL HC SUPP",2500000651,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"APRESOLINE 10MG TAB",2500000654,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"APRESOLINE 10MG TAB",2500000655,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"APRESOLINE 25MG TAB",2500000658,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"APRESOLINE 25MG TAB",2500000659,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ARICEPT 5MG TAB",2500000662,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"ARICEPT 5MG TAB",2500000663,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"TRIAMCINOLONE 0.5% CREAM",2500000666,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"TRIAMCINOLONE 0.5% CREAM",2500000667,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"ARTANE 2MG TAB",2500000670,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ARTANE 2MG TAB",2500000671,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASPIRIN 325MG TAB",2500000674,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASPIRIN 325MG TAB",2500000675,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASPIRIN EC 81MG TAB",2500000678,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASPIRIN EC 81MG TAB",2500000679,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASA 10 GRS SUPP",2500000682,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ASA 10 GRS SUPP",2500000683,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ASA 5GRS SUPP",2500000686,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ASA 5GRS SUPP",2500000687,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ASA 81MG CHEW TAB",2500000690,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ASA 81MG CHEW TAB",2500000691,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ATARAX 10MG TAB",2500000694,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ATARAX 10MG TAB",2500000695,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ATARAX 10MG/5ML SYRUP",2500000698,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ATARAX 10MG/5ML SYRUP",2500000699,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ATIVAN 1MG TABLET",2500000702,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ATIVAN 1MG TABLET",2500000703,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ATROVENT 0.02% 0.5MG/2.5ML NEB",2500000706,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ATROVENT 0.02% 0.5MG/2.5ML NEB",2500000707,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ATROPISOL 1% OPHTH SOLN",2500000710,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"ATROPISOL 1% OPHTH SOLN",2500000711,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"AUGMENTIN 500MG TAB",2500000714,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"AUGMENTIN 500MG TAB",2500000715,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"AVC VAGINAL CREAM 15% 120 GM",2500000718,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"AVC VAGINAL CREAM 15% 120 GM",2500000719,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"PAMELOR 25MG CAP",2500000722,CDM,250,RC,,,Outpatient,,,97.02,48.51,,97.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",73.74,76,,58.99,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",69.85,72,,55.88,,,0,"percent of total billed charges","72% of total billed charges",72.77,75,,58.22,,,0,"percent of total billed charges","75% of total billed charges",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.85,72,,55.88,,,0,"percent of total billed charges","72% of total billed charges",58.21,60,,46.57,,,0,"percent of total billed charges","60% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",43.66,45,,34.93,,,0,"percent of total billed charges","45% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.02,100,,,,,0,"fee schedule","100% CMS fee schedule",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.06,65,,50.45,,,0,"percent of total billed charges","65% of total billed charges",42.79,27,,34.23,,,0,"percent of total billed charges","27% of total billed charges",92.17,95,,73.74,,,0,"percent of total billed charges","95% of total billed charges",97.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",85.38,88,,68.30,,,0,"percent of total billed charges","88% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",42.79,97.02,
"PAMELOR 25MG CAP",2500000723,CDM,250,RC,,,Outpatient,,,97.02,48.51,,97.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",73.74,76,,58.99,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",69.85,72,,55.88,,,0,"percent of total billed charges","72% of total billed charges",72.77,75,,58.22,,,0,"percent of total billed charges","75% of total billed charges",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.85,72,,55.88,,,0,"percent of total billed charges","72% of total billed charges",58.21,60,,46.57,,,0,"percent of total billed charges","60% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",43.66,45,,34.93,,,0,"percent of total billed charges","45% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.02,100,,,,,0,"fee schedule","100% CMS fee schedule",97.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.06,65,,50.45,,,0,"percent of total billed charges","65% of total billed charges",42.79,27,,34.23,,,0,"percent of total billed charges","27% of total billed charges",92.17,95,,73.74,,,0,"percent of total billed charges","95% of total billed charges",97.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",85.38,88,,68.30,,,0,"percent of total billed charges","88% of total billed charges",87.32,90,,69.86,,,0,"percent of total billed charges","90% of total billed charges",42.79,97.02,
"AZULFIDINE 500MG TAB",2500000726,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"AZULFIDINE 500MG TAB",2500000727,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"B&O SUPP 30MG",2500000730,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"B&O SUPP 30MG",2500000731,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"B&O SUPP 60MG",2500000734,CDM,250,RC,,,Outpatient,,,108.05,54.025,,108.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.12,76,,65.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",77.8,72,,62.24,,,0,"percent of total billed charges","72% of total billed charges",81.04,75,,64.83,,,0,"percent of total billed charges","75% of total billed charges",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.8,72,,62.24,,,0,"percent of total billed charges","72% of total billed charges",64.83,60,,51.86,,,0,"percent of total billed charges","60% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",48.62,45,,38.90,,,0,"percent of total billed charges","45% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",108.05,100,,,,,0,"fee schedule","100% CMS fee schedule",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.23,65,,56.18,,,0,"percent of total billed charges","65% of total billed charges",47.65,27,,38.12,,,0,"percent of total billed charges","27% of total billed charges",102.65,95,,82.12,,,0,"percent of total billed charges","95% of total billed charges",108.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",95.08,88,,76.06,,,0,"percent of total billed charges","88% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",47.65,108.05,
"B&O SUPP 60MG",2500000735,CDM,250,RC,,,Outpatient,,,108.05,54.025,,108.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.12,76,,65.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",77.8,72,,62.24,,,0,"percent of total billed charges","72% of total billed charges",81.04,75,,64.83,,,0,"percent of total billed charges","75% of total billed charges",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.8,72,,62.24,,,0,"percent of total billed charges","72% of total billed charges",64.83,60,,51.86,,,0,"percent of total billed charges","60% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",48.62,45,,38.90,,,0,"percent of total billed charges","45% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",108.05,100,,,,,0,"fee schedule","100% CMS fee schedule",108.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.23,65,,56.18,,,0,"percent of total billed charges","65% of total billed charges",47.65,27,,38.12,,,0,"percent of total billed charges","27% of total billed charges",102.65,95,,82.12,,,0,"percent of total billed charges","95% of total billed charges",108.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",95.08,88,,76.06,,,0,"percent of total billed charges","88% of total billed charges",97.25,90,,77.80,,,0,"percent of total billed charges","90% of total billed charges",47.65,108.05,
"BACITRACIN OINT .5OZ",2500000738,CDM,250,RC,,,Outpatient,,,368.24,184.12,,368.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",279.86,76,,223.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",276.18,75,,220.94,,,0,"percent of total billed charges","75% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",220.94,60,,176.75,,,0,"percent of total billed charges","60% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",165.71,45,,132.57,,,0,"percent of total billed charges","45% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",239.36,65,,191.49,,,0,"percent of total billed charges","65% of total billed charges",162.39,27,,129.91,,,0,"percent of total billed charges","27% of total billed charges",349.83,95,,279.86,,,0,"percent of total billed charges","95% of total billed charges",368.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",324.05,88,,259.24,,,0,"percent of total billed charges","88% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",162.39,368.24,
"BACITRACIN OINT .5OZ",2500000739,CDM,250,RC,,,Outpatient,,,368.24,184.12,,368.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",279.86,76,,223.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",276.18,75,,220.94,,,0,"percent of total billed charges","75% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",220.94,60,,176.75,,,0,"percent of total billed charges","60% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",165.71,45,,132.57,,,0,"percent of total billed charges","45% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",239.36,65,,191.49,,,0,"percent of total billed charges","65% of total billed charges",162.39,27,,129.91,,,0,"percent of total billed charges","27% of total billed charges",349.83,95,,279.86,,,0,"percent of total billed charges","95% of total billed charges",368.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",324.05,88,,259.24,,,0,"percent of total billed charges","88% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",162.39,368.24,
"BACTRIM DS TAB",2500000742,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BACTRIM DS TAB",2500000743,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BENADRYL CREAM",2500000746,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"BENADRYL CREAM",2500000747,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"BENADRYL 25MG TAB",2500000750,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BENADRYL 25MG TAB",2500000751,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BENTYL 10MG CAP",2500000754,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"BENTYL 10MG CAP",2500000755,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SOD BICARBONATE 650MG TAB",2500000758,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SOD BICARBONATE 650MG TAB",2500000759,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BRETHINE 5MG TAB",2500000762,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"BRETHINE 5MG TAB",2500000763,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"BRETHINE 2.5MG TAB",2500000766,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BRETHINE 2.5MG TAB",2500000767,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"VITAMIN B6 50MG TAB",2500000770,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN B6 50MG TAB",2500000771,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN C 500MG TAB",2500000774,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN C 500MG TAB",2500000775,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALAN SR 180MG",2500000778,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CALAN SR 180MG",2500000779,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CAPOTEN 12.5MG TAB",2500000782,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CAPOTEN 12.5MG TAB",2500000783,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CAPOTEN 25MG TAB",2500000786,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CAPOTEN 25MG TAB",2500000787,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CARDIZEM CD 120 CAP",2500000790,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CARDIZEM CD 120 CAP",2500000791,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CARDIZEM CD 180 CAP",2500000794,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CARDIZEM CD 180 CAP",2500000795,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CARDIZEM CD 240 CAP",2500000798,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CARDIZEM CD 240 CAP",2500000799,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CARAFATE 1 GRAM TAB",2500000802,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CARAFATE 1 GRAM TAB",2500000803,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CARDIZEM TAB 60MG",2500000806,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CARDIZEM TAB 60MG",2500000807,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CATAPRES 0.1MG TAB",2500000810,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CATAPRES 0.1MG TAB",2500000811,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CEFOL TAB",2500000814,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CEFOL TAB",2500000815,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CHLORASEPTIC SPRAY",2500000818,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"CHLORASEPTIC SPRAY",2500000819,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"CHLORTHALIDONE 25MG",2500000822,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CHLORTHALIDONE 25MG",2500000823,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CITRATE OF MAGNESIA 10OZ",2500000826,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CITRATE OF MAGNESIA 10OZ",2500000827,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CLEOCIN 150MG CAP",2500000830,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CLEOCIN 150MG CAP",2500000831,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CLINORIL 200MG TAB",2500000834,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CLINORIL 200MG TAB",2500000835,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"COLACE 100MG CAP",2500000838,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"COLACE 100MG CAP",2500000839,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"COLACE 100MG/25ML UD LIQUID",2500000842,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"COLACE 100MG/25ML UD LIQUID",2500000843,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"COUMADIN 1MG TAB",2500000846,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COUMADIN 1MG TAB",2500000847,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COMBIVENT INHALER",2500000850,CDM,250,RC,,,Outpatient,,,1042.97,521.485,,1042.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",792.66,76,,634.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",750.94,72,,600.75,,,0,"percent of total billed charges","72% of total billed charges",782.23,75,,625.78,,,0,"percent of total billed charges","75% of total billed charges",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",750.94,72,,600.75,,,0,"percent of total billed charges","72% of total billed charges",625.78,60,,500.62,,,0,"percent of total billed charges","60% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",469.34,45,,375.47,,,0,"percent of total billed charges","45% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",1042.97,100,,,,,0,"fee schedule","100% CMS fee schedule",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",677.93,65,,542.34,,,0,"percent of total billed charges","65% of total billed charges",459.95,27,,367.96,,,0,"percent of total billed charges","27% of total billed charges",990.82,95,,792.66,,,0,"percent of total billed charges","95% of total billed charges",1042.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",917.81,88,,734.25,,,0,"percent of total billed charges","88% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",459.95,1042.97,
"COMBIVENT INHALER",2500000851,CDM,250,RC,,,Outpatient,,,1042.97,521.485,,1042.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",792.66,76,,634.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",750.94,72,,600.75,,,0,"percent of total billed charges","72% of total billed charges",782.23,75,,625.78,,,0,"percent of total billed charges","75% of total billed charges",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",750.94,72,,600.75,,,0,"percent of total billed charges","72% of total billed charges",625.78,60,,500.62,,,0,"percent of total billed charges","60% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",469.34,45,,375.47,,,0,"percent of total billed charges","45% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",1042.97,100,,,,,0,"fee schedule","100% CMS fee schedule",1042.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",677.93,65,,542.34,,,0,"percent of total billed charges","65% of total billed charges",459.95,27,,367.96,,,0,"percent of total billed charges","27% of total billed charges",990.82,95,,792.66,,,0,"percent of total billed charges","95% of total billed charges",1042.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",917.81,88,,734.25,,,0,"percent of total billed charges","88% of total billed charges",938.67,90,,750.94,,,0,"percent of total billed charges","90% of total billed charges",459.95,1042.97,
"CARDIZEM CD 300MG CAP",2500000854,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"CARDIZEM CD 300MG CAP",2500000855,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"GLUCOTROL XL 5MG TAB",2500000858,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GLUCOTROL XL 5MG TAB",2500000859,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"COREG 3.125MG TAB",2500000862,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREG 3.125MG TAB",2500000863,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREG 6.25 MG TAB",2500000866,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREG 6.25 MG TAB",2500000867,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CORGARD 40MG TAB",2500000870,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"CORGARD 40MG TAB",2500000871,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"COREA 12.5MG TAB",2500000874,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREA 12.5MG TAB",2500000875,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CORTENEMA 60ML",2500000878,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"CORTENEMA 60ML",2500000879,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"CORTISPORIN OTIC SOLN",2500000882,CDM,250,RC,,,Outpatient,,,381.47,190.735,,381.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",289.92,76,,231.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",274.66,72,,219.73,,,0,"percent of total billed charges","72% of total billed charges",286.1,75,,228.88,,,0,"percent of total billed charges","75% of total billed charges",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",274.66,72,,219.73,,,0,"percent of total billed charges","72% of total billed charges",228.88,60,,183.10,,,0,"percent of total billed charges","60% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",171.66,45,,137.33,,,0,"percent of total billed charges","45% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",381.47,100,,,,,0,"fee schedule","100% CMS fee schedule",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",247.96,65,,198.37,,,0,"percent of total billed charges","65% of total billed charges",168.23,27,,134.58,,,0,"percent of total billed charges","27% of total billed charges",362.4,95,,289.92,,,0,"percent of total billed charges","95% of total billed charges",381.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",335.69,88,,268.55,,,0,"percent of total billed charges","88% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",168.23,381.47,
"CORTISPORIN OTIC SOLN",2500000883,CDM,250,RC,,,Outpatient,,,381.47,190.735,,381.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",289.92,76,,231.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",274.66,72,,219.73,,,0,"percent of total billed charges","72% of total billed charges",286.1,75,,228.88,,,0,"percent of total billed charges","75% of total billed charges",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",274.66,72,,219.73,,,0,"percent of total billed charges","72% of total billed charges",228.88,60,,183.10,,,0,"percent of total billed charges","60% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",171.66,45,,137.33,,,0,"percent of total billed charges","45% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",381.47,100,,,,,0,"fee schedule","100% CMS fee schedule",381.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",247.96,65,,198.37,,,0,"percent of total billed charges","65% of total billed charges",168.23,27,,134.58,,,0,"percent of total billed charges","27% of total billed charges",362.4,95,,289.92,,,0,"percent of total billed charges","95% of total billed charges",381.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",335.69,88,,268.55,,,0,"percent of total billed charges","88% of total billed charges",343.32,90,,274.66,,,0,"percent of total billed charges","90% of total billed charges",168.23,381.47,
"CORTISPORIN OTIC SUSP",2500000886,CDM,250,RC,,,Outpatient,,,136.71,68.355,,136.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",103.9,76,,83.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",98.43,72,,78.74,,,0,"percent of total billed charges","72% of total billed charges",102.53,75,,82.02,,,0,"percent of total billed charges","75% of total billed charges",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.43,72,,78.74,,,0,"percent of total billed charges","72% of total billed charges",82.03,60,,65.62,,,0,"percent of total billed charges","60% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",61.52,45,,49.22,,,0,"percent of total billed charges","45% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",136.71,100,,,,,0,"fee schedule","100% CMS fee schedule",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.86,65,,71.09,,,0,"percent of total billed charges","65% of total billed charges",60.29,27,,48.23,,,0,"percent of total billed charges","27% of total billed charges",129.87,95,,103.90,,,0,"percent of total billed charges","95% of total billed charges",136.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",120.3,88,,96.24,,,0,"percent of total billed charges","88% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",60.29,136.71,
"CORTISPORIN OTIC SUSP",2500000887,CDM,250,RC,,,Outpatient,,,136.71,68.355,,136.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",103.9,76,,83.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",98.43,72,,78.74,,,0,"percent of total billed charges","72% of total billed charges",102.53,75,,82.02,,,0,"percent of total billed charges","75% of total billed charges",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",98.43,72,,78.74,,,0,"percent of total billed charges","72% of total billed charges",82.03,60,,65.62,,,0,"percent of total billed charges","60% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",61.52,45,,49.22,,,0,"percent of total billed charges","45% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",136.71,100,,,,,0,"fee schedule","100% CMS fee schedule",136.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.86,65,,71.09,,,0,"percent of total billed charges","65% of total billed charges",60.29,27,,48.23,,,0,"percent of total billed charges","27% of total billed charges",129.87,95,,103.90,,,0,"percent of total billed charges","95% of total billed charges",136.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",120.3,88,,96.24,,,0,"percent of total billed charges","88% of total billed charges",123.04,90,,98.43,,,0,"percent of total billed charges","90% of total billed charges",60.29,136.71,
"CORTISPORIN OPHTH SUSP",2500000890,CDM,250,RC,,,Outpatient,,,464.15,232.075,,464.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",352.75,76,,282.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",348.11,75,,278.49,,,0,"percent of total billed charges","75% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",278.49,60,,222.79,,,0,"percent of total billed charges","60% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",208.87,45,,167.10,,,0,"percent of total billed charges","45% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",301.7,65,,241.36,,,0,"percent of total billed charges","65% of total billed charges",204.69,27,,163.75,,,0,"percent of total billed charges","27% of total billed charges",440.94,95,,352.75,,,0,"percent of total billed charges","95% of total billed charges",464.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",408.45,88,,326.76,,,0,"percent of total billed charges","88% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",204.69,464.15,
"CORTISPORIN OPHTH SUSP",2500000891,CDM,250,RC,,,Outpatient,,,464.15,232.075,,464.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",352.75,76,,282.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",348.11,75,,278.49,,,0,"percent of total billed charges","75% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",278.49,60,,222.79,,,0,"percent of total billed charges","60% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",208.87,45,,167.10,,,0,"percent of total billed charges","45% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",301.7,65,,241.36,,,0,"percent of total billed charges","65% of total billed charges",204.69,27,,163.75,,,0,"percent of total billed charges","27% of total billed charges",440.94,95,,352.75,,,0,"percent of total billed charges","95% of total billed charges",464.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",408.45,88,,326.76,,,0,"percent of total billed charges","88% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",204.69,464.15,
"COUMADIN 2MG",2500000894,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COUMADIN 2MG",2500000895,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COUMADIN 5MG TAB",2500000898,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COUMADIN 5MG TAB",2500000899,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COZAAR 50MG TAB",2500000902,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"COZAAR 50MG TAB",2500000903,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"CYCLOGYL 1% OPHTH SOLN",2500000906,CDM,250,RC,,,Outpatient,,,87.1,43.55,,87.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",66.2,76,,52.96,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",65.33,75,,52.26,,,0,"percent of total billed charges","75% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",52.26,60,,41.81,,,0,"percent of total billed charges","60% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",39.2,45,,31.36,,,0,"percent of total billed charges","45% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.62,65,,45.30,,,0,"percent of total billed charges","65% of total billed charges",38.41,27,,30.73,,,0,"percent of total billed charges","27% of total billed charges",82.75,95,,66.20,,,0,"percent of total billed charges","95% of total billed charges",87.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",76.65,88,,61.32,,,0,"percent of total billed charges","88% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",38.41,87.1,
"CYCLOGYL 1% OPHTH SOLN",2500000907,CDM,250,RC,,,Outpatient,,,87.1,43.55,,87.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",66.2,76,,52.96,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",65.33,75,,52.26,,,0,"percent of total billed charges","75% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",52.26,60,,41.81,,,0,"percent of total billed charges","60% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",39.2,45,,31.36,,,0,"percent of total billed charges","45% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.62,65,,45.30,,,0,"percent of total billed charges","65% of total billed charges",38.41,27,,30.73,,,0,"percent of total billed charges","27% of total billed charges",82.75,95,,66.20,,,0,"percent of total billed charges","95% of total billed charges",87.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",76.65,88,,61.32,,,0,"percent of total billed charges","88% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",38.41,87.1,
"DALMANE 15MG CAP",2500000910,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DALMANE 15MG CAP",2500000911,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DECLOMYCIN 300MG TAB",2500000914,CDM,250,RC,,,Outpatient,,,65.05,32.525,,65.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",49.44,76,,39.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",48.79,75,,39.03,,,0,"percent of total billed charges","75% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",39.03,60,,31.22,,,0,"percent of total billed charges","60% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",29.27,45,,23.42,,,0,"percent of total billed charges","45% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,65,,33.82,,,0,"percent of total billed charges","65% of total billed charges",28.69,27,,22.95,,,0,"percent of total billed charges","27% of total billed charges",61.8,95,,49.44,,,0,"percent of total billed charges","95% of total billed charges",65.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",57.24,88,,45.79,,,0,"percent of total billed charges","88% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",28.69,65.05,
"DECLOMYCIN 300MG TAB",2500000915,CDM,250,RC,,,Outpatient,,,65.05,32.525,,65.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",49.44,76,,39.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",48.79,75,,39.03,,,0,"percent of total billed charges","75% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",39.03,60,,31.22,,,0,"percent of total billed charges","60% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",29.27,45,,23.42,,,0,"percent of total billed charges","45% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,65,,33.82,,,0,"percent of total billed charges","65% of total billed charges",28.69,27,,22.95,,,0,"percent of total billed charges","27% of total billed charges",61.8,95,,49.44,,,0,"percent of total billed charges","95% of total billed charges",65.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",57.24,88,,45.79,,,0,"percent of total billed charges","88% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",28.69,65.05,
"DERMOPLAST CAN",2500000918,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"DERMOPLAST CAN",2500000919,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"DESITIN OINT 1.24 OZ",2500000922,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"DESITIN OINT 1.24 OZ",2500000923,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"DESYREL 50MG TAB",2500000926,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DESYREL 50MG TAB",2500000927,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DIAMOX 250MG TAB",2500000930,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DIAMOX 250MG TAB",2500000931,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DILANTIN 100MG CAP",2500000934,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DILANTIN 100MG CAP",2500000935,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DILANTIN 125/5ML SUSP UD",2500000938,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DILANTIN 125/5ML SUSP UD",2500000939,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DIOVAN 80MG CAP",2500000942,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"DIOVAN 80MG CAP",2500000943,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"DITROPAN 5MG TABS",2500000946,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DITROPAN 5MG TABS",2500000947,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DONNATAL ELIXIR 5ML UD",2500000950,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DONNATAL ELIXIR 5ML UD",2500000951,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DUCOLAX 5MG TAB",2500000954,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DUCOLAX 5MG TAB",2500000955,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DUCOLAX 10MG SUPP",2500000958,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DUCOLAX 10MG SUPP",2500000959,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DURICEF 500MG CAP",2500000962,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"DURICEF 500MG CAP",2500000963,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"DYNACIRC 5MG CAP",2500000966,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"DYNACIRC 5MG CAP",2500000967,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ECOTRIN 325MG TAB",2500000970,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ECOTRIN 325MG TAB",2500000971,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ELAVIL 10MG TAB",2500000974,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ELAVIL 10MG TAB",2500000975,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ELAVIL 25MG TAB",2500000978,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ELAVIL 25MG TAB",2500000979,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ERYC 250MG CAP",2500000986,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ERYC 250MG CAP",2500000987,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"VITAMIN E 400 UNIT CAP",2500000990,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN E 400 UNIT CAP",2500000991,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FELDENE 20MG CAP",2500000994,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"FELDENE 20MG CAP",2500000995,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"FEOSOL LIQ 2OZ",2500000998,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FEOSOL LIQ 2OZ",2500000999,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FER IN SOL DROPS BTL",2500001002,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"FER IN SOL DROPS BTL",2500001003,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"FERROUS SULFATE 325MG TAB",2500001006,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FERROUS SULFATE 325MG TAB",2500001007,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FLAGYL 250MG TAB",2500001010,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"FLAGYL 250MG TAB",2500001011,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"FLEXERIL 10MG TAB",2500001014,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"FLEXERIL 10MG TAB",2500001015,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"FLORINEF 0.1MG TAB",2500001018,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"FLORINEF 0.1MG TAB",2500001019,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"FOLIC ACID 1MG TAB",2500001022,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FOLIC ACID 1MG TAB",2500001023,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DYAZIDE 50/25 CAP",2500001026,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"DYAZIDE 50/25 CAP",2500001027,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"GENTAMICIN OPHTH OINT",2500001030,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"GENTAMICIN OPHTH OINT",2500001031,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"GENTAMICIN 0.3% OPH SOL 5 ML",2500001034,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"GENTAMICIN 0.3% OPH SOL 5 ML",2500001035,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"GENTAMICIN 0.1% CREAM",2500001038,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"GENTAMICIN 0.1% CREAM",2500001039,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"GAVISCON LIQUID 1OZ",2500001042,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GAVISCON LIQUID 1OZ",2500001043,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GERITONIC LIQUID 30ML",2500001046,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GERITONIC LIQUID 30ML",2500001047,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GOLYTELY 4L",2500001050,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"GOLYTELY 4L",2500001051,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"GLUCOTROL XL 10MG TAB",2500001054,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLUCOTROL XL 10MG TAB",2500001055,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLUCOTROL 5MG TAB",2500001058,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"GLUCOTROL 5MG TAB",2500001059,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"HALCION 0.25MG TAB",2500001062,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"HALCION 0.25MG TAB",2500001063,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"HALDOL 1MG TAB",2500001066,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"HALDOL 1MG TAB",2500001067,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"HALDOL 5MG TAB",2500001070,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"HALDOL 5MG TAB",2500001071,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLYNASE 3MG PRESTAB",2500001074,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GLYNASE 3MG PRESTAB",2500001075,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"HURRICANE SPRAY",2500001078,CDM,250,RC,,,Outpatient,,,198.45,99.225,,198.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",150.82,76,,120.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",148.84,75,,119.07,,,0,"percent of total billed charges","75% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",119.07,60,,95.26,,,0,"percent of total billed charges","60% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",89.3,45,,71.44,,,0,"percent of total billed charges","45% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,65,,103.19,,,0,"percent of total billed charges","65% of total billed charges",87.52,27,,70.02,,,0,"percent of total billed charges","27% of total billed charges",188.53,95,,150.82,,,0,"percent of total billed charges","95% of total billed charges",198.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",174.64,88,,139.71,,,0,"percent of total billed charges","88% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",87.52,198.45,
"HURRICANE SPRAY",2500001079,CDM,250,RC,,,Outpatient,,,198.45,99.225,,198.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",150.82,76,,120.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",148.84,75,,119.07,,,0,"percent of total billed charges","75% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",119.07,60,,95.26,,,0,"percent of total billed charges","60% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",89.3,45,,71.44,,,0,"percent of total billed charges","45% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,65,,103.19,,,0,"percent of total billed charges","65% of total billed charges",87.52,27,,70.02,,,0,"percent of total billed charges","27% of total billed charges",188.53,95,,150.82,,,0,"percent of total billed charges","95% of total billed charges",198.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",174.64,88,,139.71,,,0,"percent of total billed charges","88% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",87.52,198.45,
"HYDROCORTISONE 2.5% CREAM",2500001082,CDM,250,RC,,,Outpatient,,,57.33,28.665,,57.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",43.57,76,,34.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",41.28,72,,33.02,,,0,"percent of total billed charges","72% of total billed charges",43,75,,34.40,,,0,"percent of total billed charges","75% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,72,,33.02,,,0,"percent of total billed charges","72% of total billed charges",34.4,60,,27.52,,,0,"percent of total billed charges","60% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.8,45,,20.64,,,0,"percent of total billed charges","45% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.26,65,,29.81,,,0,"percent of total billed charges","65% of total billed charges",25.28,27,,20.22,,,0,"percent of total billed charges","27% of total billed charges",54.46,95,,43.57,,,0,"percent of total billed charges","95% of total billed charges",57.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",50.45,88,,40.36,,,0,"percent of total billed charges","88% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.28,57.33,
"HYDROCORTISONE 2.5% CREAM",2500001083,CDM,250,RC,,,Outpatient,,,57.33,28.665,,57.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",43.57,76,,34.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",41.28,72,,33.02,,,0,"percent of total billed charges","72% of total billed charges",43,75,,34.40,,,0,"percent of total billed charges","75% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.28,72,,33.02,,,0,"percent of total billed charges","72% of total billed charges",34.4,60,,27.52,,,0,"percent of total billed charges","60% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.8,45,,20.64,,,0,"percent of total billed charges","45% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% CMS fee schedule",57.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.26,65,,29.81,,,0,"percent of total billed charges","65% of total billed charges",25.28,27,,20.22,,,0,"percent of total billed charges","27% of total billed charges",54.46,95,,43.57,,,0,"percent of total billed charges","95% of total billed charges",57.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",50.45,88,,40.36,,,0,"percent of total billed charges","88% of total billed charges",51.6,90,,41.28,,,0,"percent of total billed charges","90% of total billed charges",25.28,57.33,
"ILOTYCIN OPHTH OINT",2500001086,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"ILOTYCIN OPHTH OINT",2500001087,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"IMDUR 30 MG TAB",2500001090,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"IMDUR 30 MG TAB",2500001091,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"IMODIUM 2MG CAP",2500001094,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"IMODIUM 2MG CAP",2500001095,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"INDERAL 10MG TAB",2500001098,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"INDERAL 10MG TAB",2500001099,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"INDERAL 20MG TAB",2500001102,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"INDERAL 20MG TAB",2500001103,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"INDOCIN 25MG CAP",2500001106,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"INDOCIN 25MG CAP",2500001107,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"INSTAGLUCOSE TUBE",2500001110,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"INSTAGLUCOSE TUBE",2500001111,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"ISOPTIN 80MG TAB",2500001114,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ISOPTIN 80MG TAB",2500001115,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ISOPTIN 120MG TAB",2500001118,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ISOPTIN 120MG TAB",2500001119,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ISORDIL 10MG TAB",2500001122,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ISORDIL 10MG TAB",2500001123,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ISORDIL 20MG TAB",2500001126,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ISORDIL 20MG TAB",2500001127,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"KAOCHLOR LIQUID 40MEQ/30ML",2500001130,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"KAOCHLOR LIQUID 40MEQ/30ML",2500001131,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"KLORCON 20MEQ PKT",2500001134,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"KLORCON 20MEQ PKT",2500001135,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"KEFLEX 250MG CAP",2500001138,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"KEFLEX 250MG CAP",2500001139,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"KEFLEX 500MG CAP",2500001142,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"KEFLEX 500MG CAP",2500001143,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"KEFLEX 250MG 100ML",2500001146,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"KEFLEX 250MG 100ML",2500001147,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"KAYEXALATE 15G SUSP",2500001150,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"KAYEXALATE 15G SUSP",2500001151,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"KENALOG CR .1% 60GM",2500001154,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"KENALOG CR .1% 60GM",2500001155,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"KENALOG CR .1% 15GM",2500001158,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"KENALOG CR .1% 15GM",2500001159,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"KLONOPIN 0.5MG TAB",2500001162,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"KLONOPIN 0.5MG TAB",2500001163,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"KLYTE 25MEQ EFF TAB",2500001166,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"KLYTE 25MEQ EFF TAB",2500001167,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"KWELL LOTION 2OZ",2500001170,CDM,250,RC,,,Outpatient,,,579.92,289.96,,579.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",440.74,76,,352.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",417.54,72,,334.03,,,0,"percent of total billed charges","72% of total billed charges",434.94,75,,347.95,,,0,"percent of total billed charges","75% of total billed charges",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",417.54,72,,334.03,,,0,"percent of total billed charges","72% of total billed charges",347.95,60,,278.36,,,0,"percent of total billed charges","60% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",260.96,45,,208.77,,,0,"percent of total billed charges","45% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",579.92,100,,,,,0,"fee schedule","100% CMS fee schedule",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",376.95,65,,301.56,,,0,"percent of total billed charges","65% of total billed charges",255.74,27,,204.59,,,0,"percent of total billed charges","27% of total billed charges",550.92,95,,440.74,,,0,"percent of total billed charges","95% of total billed charges",579.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",510.33,88,,408.26,,,0,"percent of total billed charges","88% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",255.74,579.92,
"KWELL LOTION 2OZ",2500001171,CDM,250,RC,,,Outpatient,,,579.92,289.96,,579.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",440.74,76,,352.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",417.54,72,,334.03,,,0,"percent of total billed charges","72% of total billed charges",434.94,75,,347.95,,,0,"percent of total billed charges","75% of total billed charges",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",417.54,72,,334.03,,,0,"percent of total billed charges","72% of total billed charges",347.95,60,,278.36,,,0,"percent of total billed charges","60% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",260.96,45,,208.77,,,0,"percent of total billed charges","45% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",579.92,100,,,,,0,"fee schedule","100% CMS fee schedule",579.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",376.95,65,,301.56,,,0,"percent of total billed charges","65% of total billed charges",255.74,27,,204.59,,,0,"percent of total billed charges","27% of total billed charges",550.92,95,,440.74,,,0,"percent of total billed charges","95% of total billed charges",579.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",510.33,88,,408.26,,,0,"percent of total billed charges","88% of total billed charges",521.93,90,,417.54,,,0,"percent of total billed charges","90% of total billed charges",255.74,579.92,
"KWELL SHAMPOO 2OZ",2500001174,CDM,250,RC,,,Outpatient,,,554.56,277.28,,554.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",421.47,76,,337.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",399.28,72,,319.42,,,0,"percent of total billed charges","72% of total billed charges",415.92,75,,332.74,,,0,"percent of total billed charges","75% of total billed charges",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",399.28,72,,319.42,,,0,"percent of total billed charges","72% of total billed charges",332.74,60,,266.19,,,0,"percent of total billed charges","60% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",249.55,45,,199.64,,,0,"percent of total billed charges","45% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",554.56,100,,,,,0,"fee schedule","100% CMS fee schedule",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",360.46,65,,288.37,,,0,"percent of total billed charges","65% of total billed charges",244.56,27,,195.65,,,0,"percent of total billed charges","27% of total billed charges",526.83,95,,421.46,,,0,"percent of total billed charges","95% of total billed charges",554.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",488.01,88,,390.41,,,0,"percent of total billed charges","88% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",244.56,554.56,
"KWELL SHAMPOO 2OZ",2500001175,CDM,250,RC,,,Outpatient,,,554.56,277.28,,554.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",421.47,76,,337.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",399.28,72,,319.42,,,0,"percent of total billed charges","72% of total billed charges",415.92,75,,332.74,,,0,"percent of total billed charges","75% of total billed charges",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",399.28,72,,319.42,,,0,"percent of total billed charges","72% of total billed charges",332.74,60,,266.19,,,0,"percent of total billed charges","60% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",249.55,45,,199.64,,,0,"percent of total billed charges","45% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",554.56,100,,,,,0,"fee schedule","100% CMS fee schedule",554.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",360.46,65,,288.37,,,0,"percent of total billed charges","65% of total billed charges",244.56,27,,195.65,,,0,"percent of total billed charges","27% of total billed charges",526.83,95,,421.46,,,0,"percent of total billed charges","95% of total billed charges",554.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",488.01,88,,390.41,,,0,"percent of total billed charges","88% of total billed charges",499.1,90,,399.28,,,0,"percent of total billed charges","90% of total billed charges",244.56,554.56,
"LACTINEX TAB",2500001178,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LACTINEX TAB",2500001179,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LANOXIN 0.25 MG TAB",2500001182,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LANOXIN 0.25 MG TAB",2500001183,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LANOXIN 0.125MG TAB",2500001186,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LANOXIN 0.125MG TAB",2500001187,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LAMISIL CREAM",2500001190,CDM,250,RC,,,Outpatient,,,66.15,33.075,,66.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",50.27,76,,40.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",49.61,75,,39.69,,,0,"percent of total billed charges","75% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",39.69,60,,31.75,,,0,"percent of total billed charges","60% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.77,45,,23.82,,,0,"percent of total billed charges","45% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,65,,34.40,,,0,"percent of total billed charges","65% of total billed charges",29.17,27,,23.34,,,0,"percent of total billed charges","27% of total billed charges",62.84,95,,50.27,,,0,"percent of total billed charges","95% of total billed charges",66.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",58.21,88,,46.57,,,0,"percent of total billed charges","88% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.17,66.15,
"LAMISIL CREAM",2500001191,CDM,250,RC,,,Outpatient,,,66.15,33.075,,66.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",50.27,76,,40.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",49.61,75,,39.69,,,0,"percent of total billed charges","75% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",39.69,60,,31.75,,,0,"percent of total billed charges","60% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.77,45,,23.82,,,0,"percent of total billed charges","45% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,65,,34.40,,,0,"percent of total billed charges","65% of total billed charges",29.17,27,,23.34,,,0,"percent of total billed charges","27% of total billed charges",62.84,95,,50.27,,,0,"percent of total billed charges","95% of total billed charges",66.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",58.21,88,,46.57,,,0,"percent of total billed charges","88% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.17,66.15,
"LAMACTIL 100MG TAB",2500001194,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LAMACTIL 100MG TAB",2500001195,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LASIX 20MG TAB",2500001198,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LASIX 20MG TAB",2500001199,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LASIX 40MG TAB",2500001202,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LASIX 40MG TAB",2500001203,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LIBRAX CAP",2500001206,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LIBRAX CAP",2500001207,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LIBRIUM 5MG TAB",2500001210,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LIBRIUM 5MG TAB",2500001211,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LIBRIUM 10MG TAB",2500001214,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LIBRIUM 10MG TAB",2500001215,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LIBRIUM 25MG CAP",2500001218,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LIBRIUM 25MG CAP",2500001219,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ISORDIL 40MG TAB",2500001222,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ISORDIL 40MG TAB",2500001223,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"LIORESAL 10MG TAB",2500001226,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LIORESAL 10MG TAB",2500001227,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LONITEN 2.5MG TAB",2500001234,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LONITEN 2.5MG TAB",2500001235,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LOMOTIL TAB",2500001239,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LOMOTIL TAB",2500001240,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LOPRESSOR 50MG TAB",2500001243,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LOPRESSOR 50MG TAB",2500001244,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LOPRESSOR 100MG TAB",2500001247,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LOPRESSOR 100MG TAB",2500001248,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LOTRIMIN 1% CR 30GM",2500001251,CDM,250,RC,,,Outpatient,,,46.31,23.155,,46.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.2,76,,28.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",34.73,75,,27.78,,,0,"percent of total billed charges","75% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",27.79,60,,22.23,,,0,"percent of total billed charges","60% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.84,45,,16.67,,,0,"percent of total billed charges","45% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.1,65,,24.08,,,0,"percent of total billed charges","65% of total billed charges",20.42,27,,16.34,,,0,"percent of total billed charges","27% of total billed charges",43.99,95,,35.19,,,0,"percent of total billed charges","95% of total billed charges",46.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",40.75,88,,32.60,,,0,"percent of total billed charges","88% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.42,46.31,
"LOTRIMIN 1% CR 30GM",2500001252,CDM,250,RC,,,Outpatient,,,46.31,23.155,,46.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.2,76,,28.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",34.73,75,,27.78,,,0,"percent of total billed charges","75% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",27.79,60,,22.23,,,0,"percent of total billed charges","60% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.84,45,,16.67,,,0,"percent of total billed charges","45% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.1,65,,24.08,,,0,"percent of total billed charges","65% of total billed charges",20.42,27,,16.34,,,0,"percent of total billed charges","27% of total billed charges",43.99,95,,35.19,,,0,"percent of total billed charges","95% of total billed charges",46.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",40.75,88,,32.60,,,0,"percent of total billed charges","88% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.42,46.31,
"LOTRISONE CR 15GM",2500001255,CDM,250,RC,,,Outpatient,,,163.17,81.585,,163.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.01,76,,99.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",117.48,72,,93.98,,,0,"percent of total billed charges","72% of total billed charges",122.38,75,,97.90,,,0,"percent of total billed charges","75% of total billed charges",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",117.48,72,,93.98,,,0,"percent of total billed charges","72% of total billed charges",97.9,60,,78.32,,,0,"percent of total billed charges","60% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",73.43,45,,58.74,,,0,"percent of total billed charges","45% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.17,100,,,,,0,"fee schedule","100% CMS fee schedule",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.06,65,,84.85,,,0,"percent of total billed charges","65% of total billed charges",71.96,27,,57.57,,,0,"percent of total billed charges","27% of total billed charges",155.01,95,,124.01,,,0,"percent of total billed charges","95% of total billed charges",163.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",143.59,88,,114.87,,,0,"percent of total billed charges","88% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",71.96,163.17,
"LOTRISONE CR 15GM",2500001256,CDM,250,RC,,,Outpatient,,,163.17,81.585,,163.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.01,76,,99.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",117.48,72,,93.98,,,0,"percent of total billed charges","72% of total billed charges",122.38,75,,97.90,,,0,"percent of total billed charges","75% of total billed charges",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",117.48,72,,93.98,,,0,"percent of total billed charges","72% of total billed charges",97.9,60,,78.32,,,0,"percent of total billed charges","60% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",73.43,45,,58.74,,,0,"percent of total billed charges","45% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.17,100,,,,,0,"fee schedule","100% CMS fee schedule",163.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.06,65,,84.85,,,0,"percent of total billed charges","65% of total billed charges",71.96,27,,57.57,,,0,"percent of total billed charges","27% of total billed charges",155.01,95,,124.01,,,0,"percent of total billed charges","95% of total billed charges",163.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",143.59,88,,114.87,,,0,"percent of total billed charges","88% of total billed charges",146.85,90,,117.48,,,0,"percent of total billed charges","90% of total billed charges",71.96,163.17,
"LOZOL 2.5MG TAB",2500001259,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LOZOL 2.5MG TAB",2500001260,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MAALOX 30ML",2500001263,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"MAALOX 30ML",2500001264,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"MACRODANTIN 50MG CAP",2500001267,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MACRODANTIN 50MG CAP",2500001268,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MACRODANTIN 100MG CAP",2500001271,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MACRODANTIN 100MG CAP",2500001272,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MACROBID 100MG CAP",2500001275,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"MACROBID 100MG CAP",2500001276,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"MEGACE 40MG TAB",2500001279,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MEGACE 40MG TAB",2500001280,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MEPHYTON 5MG TAB",2500001283,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"MEPHYTON 5MG TAB",2500001284,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"METHADONE 10 MG TAB",2500001287,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"METHADONE 10 MG TAB",2500001288,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"METAMUCIL PKT",2500001291,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"METAMUCIL PKT",2500001292,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"METHERGINE 0.2MG TAB",2500001295,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"METHERGINE 0.2MG TAB",2500001296,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MICRONASE 2.5MG TAB",2500001299,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MICRONASE 2.5MG TAB",2500001300,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MICRONASE 5MG TAB",2500001303,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MICRONASE 5MG TAB",2500001304,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MILK OF MAGNESIA 30ML",2500001307,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MILK OF MAGNESIA 30ML",2500001308,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MINERAL OIL 30ML",2500001311,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MINERAL OIL 30ML",2500001312,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MINOCIN 100MG CAP",2500001315,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"MINOCIN 100MG CAP",2500001316,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"MONISTAT DERM 2% CR",2500001319,CDM,250,RC,,,Outpatient,,,115.76,57.88,,115.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.98,76,,70.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",86.82,75,,69.46,,,0,"percent of total billed charges","75% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",69.46,60,,55.57,,,0,"percent of total billed charges","60% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",52.09,45,,41.67,,,0,"percent of total billed charges","45% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",75.24,65,,60.19,,,0,"percent of total billed charges","65% of total billed charges",51.05,27,,40.84,,,0,"percent of total billed charges","27% of total billed charges",109.97,95,,87.98,,,0,"percent of total billed charges","95% of total billed charges",115.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",101.87,88,,81.50,,,0,"percent of total billed charges","88% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",51.05,115.76,
"MONISTAT DERM 2% CR",2500001320,CDM,250,RC,,,Outpatient,,,115.76,57.88,,115.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.98,76,,70.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",86.82,75,,69.46,,,0,"percent of total billed charges","75% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.35,72,,66.68,,,0,"percent of total billed charges","72% of total billed charges",69.46,60,,55.57,,,0,"percent of total billed charges","60% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",52.09,45,,41.67,,,0,"percent of total billed charges","45% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% CMS fee schedule",115.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",75.24,65,,60.19,,,0,"percent of total billed charges","65% of total billed charges",51.05,27,,40.84,,,0,"percent of total billed charges","27% of total billed charges",109.97,95,,87.98,,,0,"percent of total billed charges","95% of total billed charges",115.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",101.87,88,,81.50,,,0,"percent of total billed charges","88% of total billed charges",104.18,90,,83.34,,,0,"percent of total billed charges","90% of total billed charges",51.05,115.76,
"MONOPRIL 10MG TAB",2500001323,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"MONOPRIL 10MG TAB",2500001324,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"MOTRIN 800MG TAB",2500001327,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MOTRIN 800MG TAB",2500001328,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MOTRIN 400MG TAB",2500001331,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MOTRIN 400MG TAB",2500001332,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MOTRIN 600MG TAB",2500001335,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"MOTRIN 600MG TAB",2500001336,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"MUCOMYST INH SOLN 30ML",2500001339,CDM,250,RC,J7604,HCPCS,Outpatient,,,39.69,19.845,U8,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"MUCOMYST INH SOLN 30ML",2500001340,CDM,250,RC,J7604,HCPCS,Outpatient,,,39.69,19.845,U8,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"MUCOMYST SOL 30ML",2500001343,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"MUCOMYST SOL 30ML",2500001344,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"MYAMBUTOL 400MG TAB",2500001347,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"MYAMBUTOL 400MG TAB",2500001348,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PLAVIX 300MG TABLET",2500001351,CDM,250,RC,,,Outpatient,,,84.89,42.445,,84.89,125,,,,,0,"fee schedule","125% of CMS fee schedule",64.52,76,,51.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",63.67,75,,50.94,,,0,"percent of total billed charges","75% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",50.93,60,,40.74,,,0,"percent of total billed charges","60% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",38.2,45,,30.56,,,0,"percent of total billed charges","45% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.18,65,,44.14,,,0,"percent of total billed charges","65% of total billed charges",37.44,27,,29.95,,,0,"percent of total billed charges","27% of total billed charges",80.65,95,,64.52,,,0,"percent of total billed charges","95% of total billed charges",84.89,75,,,,,0,"fee schedule","75% of CMS fee schedule",74.7,88,,59.76,,,0,"percent of total billed charges","88% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",37.44,84.89,
"PLAVIX 300MG TABLET",2500001352,CDM,250,RC,,,Outpatient,,,84.89,42.445,,84.89,125,,,,,0,"fee schedule","125% of CMS fee schedule",64.52,76,,51.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",63.67,75,,50.94,,,0,"percent of total billed charges","75% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.12,72,,48.90,,,0,"percent of total billed charges","72% of total billed charges",50.93,60,,40.74,,,0,"percent of total billed charges","60% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",38.2,45,,30.56,,,0,"percent of total billed charges","45% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% CMS fee schedule",84.89,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.18,65,,44.14,,,0,"percent of total billed charges","65% of total billed charges",37.44,27,,29.95,,,0,"percent of total billed charges","27% of total billed charges",80.65,95,,64.52,,,0,"percent of total billed charges","95% of total billed charges",84.89,75,,,,,0,"fee schedule","75% of CMS fee schedule",74.7,88,,59.76,,,0,"percent of total billed charges","88% of total billed charges",76.4,90,,61.12,,,0,"percent of total billed charges","90% of total billed charges",37.44,84.89,
"CAMPRAL 333MG TAB",2510000000,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"CAMPRAL 333MG TAB",2550000001,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MYCOSTATIN TOPICAL POWDER",2550000004,CDM,250,RC,,,Outpatient,,,122.38,61.19,,122.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",93.01,76,,74.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",88.11,72,,70.49,,,0,"percent of total billed charges","72% of total billed charges",91.79,75,,73.43,,,0,"percent of total billed charges","75% of total billed charges",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.11,72,,70.49,,,0,"percent of total billed charges","72% of total billed charges",73.43,60,,58.74,,,0,"percent of total billed charges","60% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",55.07,45,,44.06,,,0,"percent of total billed charges","45% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",122.38,100,,,,,0,"fee schedule","100% CMS fee schedule",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.55,65,,63.64,,,0,"percent of total billed charges","65% of total billed charges",53.97,27,,43.18,,,0,"percent of total billed charges","27% of total billed charges",116.26,95,,93.01,,,0,"percent of total billed charges","95% of total billed charges",122.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",107.69,88,,86.15,,,0,"percent of total billed charges","88% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",53.97,122.38,
"MYCOSTATIN TOPICAL POWDER",2550000005,CDM,250,RC,,,Outpatient,,,122.38,61.19,,122.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",93.01,76,,74.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",88.11,72,,70.49,,,0,"percent of total billed charges","72% of total billed charges",91.79,75,,73.43,,,0,"percent of total billed charges","75% of total billed charges",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.11,72,,70.49,,,0,"percent of total billed charges","72% of total billed charges",73.43,60,,58.74,,,0,"percent of total billed charges","60% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",55.07,45,,44.06,,,0,"percent of total billed charges","45% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",122.38,100,,,,,0,"fee schedule","100% CMS fee schedule",122.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.55,65,,63.64,,,0,"percent of total billed charges","65% of total billed charges",53.97,27,,43.18,,,0,"percent of total billed charges","27% of total billed charges",116.26,95,,93.01,,,0,"percent of total billed charges","95% of total billed charges",122.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",107.69,88,,86.15,,,0,"percent of total billed charges","88% of total billed charges",110.14,90,,88.11,,,0,"percent of total billed charges","90% of total billed charges",53.97,122.38,
"MYDRIACYL 1 0/0 OPTH SOLN",2550000008,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"MYDRIACYL 1 0/0 OPTH SOLN",2550000009,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"MYLANTA SUSP 30ML",2550000012,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MYLANTA SUSP 30ML",2550000013,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MYLICON 80MG TAB",2550000016,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MYLICON 80MG TAB",2550000017,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MYLICON DROPS 40MG/0.6ML 30ML",2550000020,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MYLICON DROPS 40MG/0.6ML 30ML",2550000021,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MYSOLINE 250MG TAB",2580000002,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MYSOLINE 250MG TAB",2580000003,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NAPHCON A OPHTH SOLN",2580000006,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"NAPHCON A OPHTH SOLN",2580000007,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"NAPROSYN 250MG TAB",2580000010,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NAPROSYN 250MG TAB",2580000011,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NAPROSYN 375MG TAB",2580000014,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NAPROSYN 375MG TAB",2580000015,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MAXITROL OPHTH OINT",2580000018,CDM,250,RC,,,Outpatient,,,178.61,89.305,,178.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",135.74,76,,108.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",128.6,72,,102.88,,,0,"percent of total billed charges","72% of total billed charges",133.96,75,,107.17,,,0,"percent of total billed charges","75% of total billed charges",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.6,72,,102.88,,,0,"percent of total billed charges","72% of total billed charges",107.17,60,,85.74,,,0,"percent of total billed charges","60% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",80.37,45,,64.30,,,0,"percent of total billed charges","45% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.61,100,,,,,0,"fee schedule","100% CMS fee schedule",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.1,65,,92.88,,,0,"percent of total billed charges","65% of total billed charges",78.77,27,,63.02,,,0,"percent of total billed charges","27% of total billed charges",169.68,95,,135.74,,,0,"percent of total billed charges","95% of total billed charges",178.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",157.18,88,,125.74,,,0,"percent of total billed charges","88% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",78.77,178.61,
"MAXITROL OPHTH OINT",2580000019,CDM,250,RC,,,Outpatient,,,178.61,89.305,,178.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",135.74,76,,108.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",128.6,72,,102.88,,,0,"percent of total billed charges","72% of total billed charges",133.96,75,,107.17,,,0,"percent of total billed charges","75% of total billed charges",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.6,72,,102.88,,,0,"percent of total billed charges","72% of total billed charges",107.17,60,,85.74,,,0,"percent of total billed charges","60% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",80.37,45,,64.30,,,0,"percent of total billed charges","45% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.61,100,,,,,0,"fee schedule","100% CMS fee schedule",178.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.1,65,,92.88,,,0,"percent of total billed charges","65% of total billed charges",78.77,27,,63.02,,,0,"percent of total billed charges","27% of total billed charges",169.68,95,,135.74,,,0,"percent of total billed charges","95% of total billed charges",178.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",157.18,88,,125.74,,,0,"percent of total billed charges","88% of total billed charges",160.75,90,,128.60,,,0,"percent of total billed charges","90% of total billed charges",78.77,178.61,
"NEODECADRON OPHTH SUSP",2580000022,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"NEODECADRON OPHTH SUSP",2580000023,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"NEOMYCIN 500MG TAB",2580000026,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NEOMYCIN 500MG TAB",2580000027,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NEURONTIN 100MG CAP",2580000030,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NEURONTIN 100MG CAP",2580000031,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NEURONTIN 300MG CAP",2580000034,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"NEURONTIN 300MG CAP",2580000035,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"TRIPLE ANTIBIOTIC 28.4 GM",2580000038,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"TRIPLE ANTIBIOTIC 28.4 GM",2580000039,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"NEOSYNEPHNE 0.25% NASAL SOLN",2600000001,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"NEOSYNEPHNE 0.25% NASAL SOLN",2600000002,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"NITROGLY 1/150GR TAB",2600000005,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"NITROGLY 1/150GR TAB",2600000006,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"NITROLINGUAL SPRAY 4.9GM",2600000009,CDM,250,RC,,,Outpatient,,,145.53,72.765,,145.53,125,,,,,0,"fee schedule","125% of CMS fee schedule",110.6,76,,88.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",104.78,72,,83.82,,,0,"percent of total billed charges","72% of total billed charges",109.15,75,,87.32,,,0,"percent of total billed charges","75% of total billed charges",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.78,72,,83.82,,,0,"percent of total billed charges","72% of total billed charges",87.32,60,,69.86,,,0,"percent of total billed charges","60% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",65.49,45,,52.39,,,0,"percent of total billed charges","45% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",145.53,100,,,,,0,"fee schedule","100% CMS fee schedule",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.59,65,,75.67,,,0,"percent of total billed charges","65% of total billed charges",64.18,27,,51.34,,,0,"percent of total billed charges","27% of total billed charges",138.25,95,,110.60,,,0,"percent of total billed charges","95% of total billed charges",145.53,75,,,,,0,"fee schedule","75% of CMS fee schedule",128.07,88,,102.46,,,0,"percent of total billed charges","88% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",64.18,145.53,
"NITROLINGUAL SPRAY 4.9GM",2600000010,CDM,250,RC,,,Outpatient,,,145.53,72.765,,145.53,125,,,,,0,"fee schedule","125% of CMS fee schedule",110.6,76,,88.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",104.78,72,,83.82,,,0,"percent of total billed charges","72% of total billed charges",109.15,75,,87.32,,,0,"percent of total billed charges","75% of total billed charges",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",104.78,72,,83.82,,,0,"percent of total billed charges","72% of total billed charges",87.32,60,,69.86,,,0,"percent of total billed charges","60% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",65.49,45,,52.39,,,0,"percent of total billed charges","45% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",145.53,100,,,,,0,"fee schedule","100% CMS fee schedule",145.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.59,65,,75.67,,,0,"percent of total billed charges","65% of total billed charges",64.18,27,,51.34,,,0,"percent of total billed charges","27% of total billed charges",138.25,95,,110.60,,,0,"percent of total billed charges","95% of total billed charges",145.53,75,,,,,0,"fee schedule","75% of CMS fee schedule",128.07,88,,102.46,,,0,"percent of total billed charges","88% of total billed charges",130.98,90,,104.78,,,0,"percent of total billed charges","90% of total billed charges",64.18,145.53,
"NOLVADEX 10MG PO",2600000013,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NOLVADEX 10MG PO",2600000014,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NORMODYNE 200MG TAB",2600000017,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NORMODYNE 200MG TAB",2600000018,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NORVASC 5MG TAB",2600000021,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NORVASC 5MG TAB",2600000022,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NORVASC 10MG TAB",2600000025,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NORVASC 10MG TAB",2600000026,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NU GUAZE .25 IN",2700000003,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NU GUAZE .25 IN",2700000004,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NU GUAZE .5 IN",2700000007,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NU GUAZE .5 IN",2700000008,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NU GUAZE 1IN",2700000011,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NU GUAZE 1IN",2700000012,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"NYSTATIN CREAM 30G",2700000015,CDM,250,RC,,,Outpatient,,,106.94,53.47,,106.94,125,,,,,0,"fee schedule","125% of CMS fee schedule",81.27,76,,65.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",77,72,,61.60,,,0,"percent of total billed charges","72% of total billed charges",80.21,75,,64.17,,,0,"percent of total billed charges","75% of total billed charges",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",77,72,,61.60,,,0,"percent of total billed charges","72% of total billed charges",64.16,60,,51.33,,,0,"percent of total billed charges","60% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",48.12,45,,38.50,,,0,"percent of total billed charges","45% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.94,100,,,,,0,"fee schedule","100% CMS fee schedule",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.51,65,,55.61,,,0,"percent of total billed charges","65% of total billed charges",47.16,27,,37.73,,,0,"percent of total billed charges","27% of total billed charges",101.59,95,,81.27,,,0,"percent of total billed charges","95% of total billed charges",106.94,75,,,,,0,"fee schedule","75% of CMS fee schedule",94.11,88,,75.29,,,0,"percent of total billed charges","88% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",47.16,106.94,
"NYSTATIN CREAM 30G",2700000016,CDM,250,RC,,,Outpatient,,,106.94,53.47,,106.94,125,,,,,0,"fee schedule","125% of CMS fee schedule",81.27,76,,65.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",77,72,,61.60,,,0,"percent of total billed charges","72% of total billed charges",80.21,75,,64.17,,,0,"percent of total billed charges","75% of total billed charges",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",77,72,,61.60,,,0,"percent of total billed charges","72% of total billed charges",64.16,60,,51.33,,,0,"percent of total billed charges","60% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",48.12,45,,38.50,,,0,"percent of total billed charges","45% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.94,100,,,,,0,"fee schedule","100% CMS fee schedule",106.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.51,65,,55.61,,,0,"percent of total billed charges","65% of total billed charges",47.16,27,,37.73,,,0,"percent of total billed charges","27% of total billed charges",101.59,95,,81.27,,,0,"percent of total billed charges","95% of total billed charges",106.94,75,,,,,0,"fee schedule","75% of CMS fee schedule",94.11,88,,75.29,,,0,"percent of total billed charges","88% of total billed charges",96.25,90,,77.00,,,0,"percent of total billed charges","90% of total billed charges",47.16,106.94,
"KETOCONAZOLE 200MG TAB",2700000019,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"KETOCONAZOLE 200MG TAB",2700000020,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"CALCIUM + D 250/125 TAB",2700000023,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALCIUM + D 250/125 TAB",2700000024,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALCIUM + D 500/200 TAB",2700000027,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALCIUM + D 500/200 TAB",2700000028,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PANCREASE 5000 UNIT CAP",2700000031,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PANCREASE 5000 UNIT CAP",2700000032,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PARLODEL 2.5MG TAB",2700000035,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PARLODEL 2.5MG TAB",2700000036,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PAVABID 150MG CAP",2700000039,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PAVABID 150MG CAP",2700000040,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PENVEE K 250MG",2700000043,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PENVEE K 250MG",2700000044,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PEPTO BISMOL 4OZ",2700000047,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PEPTO BISMOL 4OZ",2700000048,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PERIACTIN 4MG TAB",2700000051,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PERIACTIN 4MG TAB",2700000052,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LEVAQUIN 500MG TAB",2700000055,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"LEVAQUIN 500MG TAB",2700000056,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"LIPITOR 10MG TAB",2700000059,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"LIPITOR 10MG TAB",2700000060,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"PERICOLACE CAP",2700000063,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PERICOLACE CAP",2700000064,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PERSANTINE 25MG TAB",2700000067,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PERSANTINE 25MG TAB",2700000068,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PHENOBARB 30MG TAB",2700000071,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PHENOBARB 30MG TAB",2700000072,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PHENERGAN 25MG TAB",2700000075,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PHENERGAN 25MG TAB",2700000076,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PHENERGAN 12.5 SUPP",2700000079,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"PHENERGAN 12.5 SUPP",2700000080,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"PILOCAR 1% OPHTH SOLN",2700000083,CDM,250,RC,,,Outpatient,,,262.4,131.2,,262.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",199.42,76,,159.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",196.8,75,,157.44,,,0,"percent of total billed charges","75% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",157.44,60,,125.95,,,0,"percent of total billed charges","60% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",118.08,45,,94.46,,,0,"percent of total billed charges","45% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",170.56,65,,136.45,,,0,"percent of total billed charges","65% of total billed charges",115.72,27,,92.58,,,0,"percent of total billed charges","27% of total billed charges",249.28,95,,199.42,,,0,"percent of total billed charges","95% of total billed charges",262.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",230.91,88,,184.73,,,0,"percent of total billed charges","88% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",115.72,262.4,
"PILOCAR 1% OPHTH SOLN",2700000084,CDM,250,RC,,,Outpatient,,,262.4,131.2,,262.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",199.42,76,,159.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",196.8,75,,157.44,,,0,"percent of total billed charges","75% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",157.44,60,,125.95,,,0,"percent of total billed charges","60% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",118.08,45,,94.46,,,0,"percent of total billed charges","45% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",170.56,65,,136.45,,,0,"percent of total billed charges","65% of total billed charges",115.72,27,,92.58,,,0,"percent of total billed charges","27% of total billed charges",249.28,95,,199.42,,,0,"percent of total billed charges","95% of total billed charges",262.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",230.91,88,,184.73,,,0,"percent of total billed charges","88% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",115.72,262.4,
"PILOCAR 2% OPHTH SOLN",2700000087,CDM,250,RC,,,Outpatient,,,267.91,133.955,,267.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",203.61,76,,162.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.9,72,,154.32,,,0,"percent of total billed charges","72% of total billed charges",200.93,75,,160.74,,,0,"percent of total billed charges","75% of total billed charges",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.9,72,,154.32,,,0,"percent of total billed charges","72% of total billed charges",160.75,60,,128.60,,,0,"percent of total billed charges","60% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",120.56,45,,96.45,,,0,"percent of total billed charges","45% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",267.91,100,,,,,0,"fee schedule","100% CMS fee schedule",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.14,65,,139.31,,,0,"percent of total billed charges","65% of total billed charges",118.15,27,,94.52,,,0,"percent of total billed charges","27% of total billed charges",254.51,95,,203.61,,,0,"percent of total billed charges","95% of total billed charges",267.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",235.76,88,,188.61,,,0,"percent of total billed charges","88% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",118.15,267.91,
"PILOCAR 2% OPHTH SOLN",2700000088,CDM,250,RC,,,Outpatient,,,267.91,133.955,,267.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",203.61,76,,162.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.9,72,,154.32,,,0,"percent of total billed charges","72% of total billed charges",200.93,75,,160.74,,,0,"percent of total billed charges","75% of total billed charges",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.9,72,,154.32,,,0,"percent of total billed charges","72% of total billed charges",160.75,60,,128.60,,,0,"percent of total billed charges","60% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",120.56,45,,96.45,,,0,"percent of total billed charges","45% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",267.91,100,,,,,0,"fee schedule","100% CMS fee schedule",267.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.14,65,,139.31,,,0,"percent of total billed charges","65% of total billed charges",118.15,27,,94.52,,,0,"percent of total billed charges","27% of total billed charges",254.51,95,,203.61,,,0,"percent of total billed charges","95% of total billed charges",267.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",235.76,88,,188.61,,,0,"percent of total billed charges","88% of total billed charges",241.12,90,,192.90,,,0,"percent of total billed charges","90% of total billed charges",118.15,267.91,
"PLAVIX 75MG TAB",2700000091,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"PLAVIX 75MG TAB",2700000092,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"PLAQUENIL 200MG TAB",2700000095,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PLAQUENIL 200MG TAB",2700000096,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PLENDIL 5MG TAB",2700000099,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PLENDIL 5MG TAB",2700000100,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"POLYCIL 250/5 SUSP 100ML",2700000103,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"POLYCIL 250/5 SUSP 100ML",2700000104,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"POLYCILLIN 250 CAP",2700000107,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"POLYCILLIN 250 CAP",2700000108,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"POLYCILLIN 500 CAP",2700000111,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"POLYCILLIN 500 CAP",2700000112,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AMOXICILN 250MG/5ML SUSP 80ML",2700000115,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"AMOXICILN 250MG/5ML SUSP 80ML",2700000116,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"PRED FORTE 1% OPTH SOLN",2700000119,CDM,250,RC,,,Outpatient,,,191.84,95.92,,191.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",145.8,76,,116.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",138.12,72,,110.50,,,0,"percent of total billed charges","72% of total billed charges",143.88,75,,115.10,,,0,"percent of total billed charges","75% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",138.12,72,,110.50,,,0,"percent of total billed charges","72% of total billed charges",115.1,60,,92.08,,,0,"percent of total billed charges","60% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",86.33,45,,69.06,,,0,"percent of total billed charges","45% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.7,65,,99.76,,,0,"percent of total billed charges","65% of total billed charges",84.6,27,,67.68,,,0,"percent of total billed charges","27% of total billed charges",182.25,95,,145.80,,,0,"percent of total billed charges","95% of total billed charges",191.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",168.82,88,,135.06,,,0,"percent of total billed charges","88% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",84.6,191.84,
"PRED FORTE 1% OPTH SOLN",2700000120,CDM,250,RC,,,Outpatient,,,191.84,95.92,,191.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",145.8,76,,116.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",138.12,72,,110.50,,,0,"percent of total billed charges","72% of total billed charges",143.88,75,,115.10,,,0,"percent of total billed charges","75% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",138.12,72,,110.50,,,0,"percent of total billed charges","72% of total billed charges",115.1,60,,92.08,,,0,"percent of total billed charges","60% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",86.33,45,,69.06,,,0,"percent of total billed charges","45% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.7,65,,99.76,,,0,"percent of total billed charges","65% of total billed charges",84.6,27,,67.68,,,0,"percent of total billed charges","27% of total billed charges",182.25,95,,145.80,,,0,"percent of total billed charges","95% of total billed charges",191.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",168.82,88,,135.06,,,0,"percent of total billed charges","88% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",84.6,191.84,
"PREDNISONE 1MG TAB",2700000123,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 1MG TAB",2700000124,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 5MG TAB",2700000127,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 5MG TAB",2700000128,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 10MG TAB",2700000131,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 10MG TAB",2700000132,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 20MG TAB",2700000135,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREDNISONE 20MG TAB",2700000136,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PREMARIN 0.3MG TAB",2700000139,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PREMARIN 0.3MG TAB",2700000140,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PREMARIN .625MG TAB",2700000143,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PREMARIN .625MG TAB",2700000144,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PROCARDIA 10MG CAP",2700000147,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PROCARDIA 10MG CAP",2700000148,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PROCARDIA 60MG XL TAB",2700000151,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PROCARDIA 60MG XL TAB",2700000152,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PROCTOFOAM 15G",2700000155,CDM,250,RC,,,Outpatient,,,199.55,99.775,,199.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",151.66,76,,121.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",143.68,72,,114.94,,,0,"percent of total billed charges","72% of total billed charges",149.66,75,,119.73,,,0,"percent of total billed charges","75% of total billed charges",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.68,72,,114.94,,,0,"percent of total billed charges","72% of total billed charges",119.73,60,,95.78,,,0,"percent of total billed charges","60% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",89.8,45,,71.84,,,0,"percent of total billed charges","45% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.55,100,,,,,0,"fee schedule","100% CMS fee schedule",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.71,65,,103.77,,,0,"percent of total billed charges","65% of total billed charges",88,27,,70.40,,,0,"percent of total billed charges","27% of total billed charges",189.57,95,,151.66,,,0,"percent of total billed charges","95% of total billed charges",199.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",175.6,88,,140.48,,,0,"percent of total billed charges","88% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",88,199.55,
"PROCTOFOAM 15G",2700000156,CDM,250,RC,,,Outpatient,,,199.55,99.775,,199.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",151.66,76,,121.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",143.68,72,,114.94,,,0,"percent of total billed charges","72% of total billed charges",149.66,75,,119.73,,,0,"percent of total billed charges","75% of total billed charges",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",143.68,72,,114.94,,,0,"percent of total billed charges","72% of total billed charges",119.73,60,,95.78,,,0,"percent of total billed charges","60% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",89.8,45,,71.84,,,0,"percent of total billed charges","45% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.55,100,,,,,0,"fee schedule","100% CMS fee schedule",199.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.71,65,,103.77,,,0,"percent of total billed charges","65% of total billed charges",88,27,,70.40,,,0,"percent of total billed charges","27% of total billed charges",189.57,95,,151.66,,,0,"percent of total billed charges","95% of total billed charges",199.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",175.6,88,,140.48,,,0,"percent of total billed charges","88% of total billed charges",179.6,90,,143.68,,,0,"percent of total billed charges","90% of total billed charges",88,199.55,
"PROCTOFOAM HC 15MG",2700000159,CDM,250,RC,,,Outpatient,,,323.03,161.515,,323.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",245.5,76,,196.40,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",232.58,72,,186.06,,,0,"percent of total billed charges","72% of total billed charges",242.27,75,,193.82,,,0,"percent of total billed charges","75% of total billed charges",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",232.58,72,,186.06,,,0,"percent of total billed charges","72% of total billed charges",193.82,60,,155.06,,,0,"percent of total billed charges","60% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",145.36,45,,116.29,,,0,"percent of total billed charges","45% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",323.03,100,,,,,0,"fee schedule","100% CMS fee schedule",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",209.97,65,,167.98,,,0,"percent of total billed charges","65% of total billed charges",142.46,27,,113.97,,,0,"percent of total billed charges","27% of total billed charges",306.88,95,,245.50,,,0,"percent of total billed charges","95% of total billed charges",323.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",284.27,88,,227.42,,,0,"percent of total billed charges","88% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",142.46,323.03,
"PROCTOFOAM HC 15MG",2700000161,CDM,250,RC,,,Outpatient,,,323.03,161.515,,323.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",245.5,76,,196.40,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",232.58,72,,186.06,,,0,"percent of total billed charges","72% of total billed charges",242.27,75,,193.82,,,0,"percent of total billed charges","75% of total billed charges",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",232.58,72,,186.06,,,0,"percent of total billed charges","72% of total billed charges",193.82,60,,155.06,,,0,"percent of total billed charges","60% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",145.36,45,,116.29,,,0,"percent of total billed charges","45% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",323.03,100,,,,,0,"fee schedule","100% CMS fee schedule",323.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",209.97,65,,167.98,,,0,"percent of total billed charges","65% of total billed charges",142.46,27,,113.97,,,0,"percent of total billed charges","27% of total billed charges",306.88,95,,245.50,,,0,"percent of total billed charges","95% of total billed charges",323.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",284.27,88,,227.42,,,0,"percent of total billed charges","88% of total billed charges",290.73,90,,232.58,,,0,"percent of total billed charges","90% of total billed charges",142.46,323.03,
"ALTACE 5MG CAP",2700000164,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ALTACE 5MG CAP",2700000165,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"IMDUR 60MG TAB",2700000169,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"IMDUR 60MG TAB",2700000170,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"SEREVENT INHALER",2700000173,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"SEREVENT INHALER",2700000174,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"PROSCAR 5MG TAB",2700000177,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PROSCAR 5MG TAB",2700000178,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PROVERA 10MG TAB",2700000181,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROVERA 10MG TAB",2700000182,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PYRIDIUM 100MG TAB",2700000185,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PYRIDIUM 100MG TAB",2700000186,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"QUESTRAN 9GM POWDER",2700000189,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"QUESTRAN 9GM POWDER",2700000190,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NABUMETONE 500MG TAB",2700000193,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"NABUMETONE 500MG TAB",2700000194,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"REGLAN 10MG TAB",2700000197,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"REGLAN 10MG TAB",2700000198,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"RESTORIL 15MG CAP",2700000201,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"RESTORIL 15MG CAP",2700000202,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"RIFADIN 300MG CAP",2700000205,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"RIFADIN 300MG CAP",2700000206,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"ROBAXIN 500MG TAB",2700000209,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ROBAXIN 500MG TAB",2700000210,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ROBINUL 1MG TAB",2700000213,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ROBINUL 1MG TAB",2700000214,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ROBITUSSIN AC SYRUP 5ML UD",2700000217,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ROBITUSSIN AC SYRUP 5ML UD",2700000218,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SANTYL OINT COL 30G",2700000221,CDM,250,RC,,,Outpatient,,,263.5,131.75,,263.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",200.26,76,,160.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",189.72,72,,151.78,,,0,"percent of total billed charges","72% of total billed charges",197.63,75,,158.10,,,0,"percent of total billed charges","75% of total billed charges",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.72,72,,151.78,,,0,"percent of total billed charges","72% of total billed charges",158.1,60,,126.48,,,0,"percent of total billed charges","60% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",118.58,45,,94.86,,,0,"percent of total billed charges","45% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,100,,,,,0,"fee schedule","100% CMS fee schedule",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.28,65,,137.02,,,0,"percent of total billed charges","65% of total billed charges",116.2,27,,92.96,,,0,"percent of total billed charges","27% of total billed charges",250.33,95,,200.26,,,0,"percent of total billed charges","95% of total billed charges",263.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",231.88,88,,185.50,,,0,"percent of total billed charges","88% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",116.2,263.5,
"SANTYL OINT COL 30G",2700000222,CDM,250,RC,,,Outpatient,,,263.5,131.75,,263.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",200.26,76,,160.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",189.72,72,,151.78,,,0,"percent of total billed charges","72% of total billed charges",197.63,75,,158.10,,,0,"percent of total billed charges","75% of total billed charges",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.72,72,,151.78,,,0,"percent of total billed charges","72% of total billed charges",158.1,60,,126.48,,,0,"percent of total billed charges","60% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",118.58,45,,94.86,,,0,"percent of total billed charges","45% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",263.5,100,,,,,0,"fee schedule","100% CMS fee schedule",263.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.28,65,,137.02,,,0,"percent of total billed charges","65% of total billed charges",116.2,27,,92.96,,,0,"percent of total billed charges","27% of total billed charges",250.33,95,,200.26,,,0,"percent of total billed charges","95% of total billed charges",263.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",231.88,88,,185.50,,,0,"percent of total billed charges","88% of total billed charges",237.15,90,,189.72,,,0,"percent of total billed charges","90% of total billed charges",116.2,263.5,
"SENOKOT TABLET",2700000225,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SENOKOT TABLET",2700000226,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SEPTRA 200  40MG / 5ML",2700000229,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SEPTRA 200  40MG / 5ML",2700000230,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SILVADENE CREAM JAR 400G",2700000233,CDM,250,RC,,,Outpatient,,,156.56,78.28,,156.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",118.99,76,,95.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",117.42,75,,93.94,,,0,"percent of total billed charges","75% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",93.94,60,,75.15,,,0,"percent of total billed charges","60% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",70.45,45,,56.36,,,0,"percent of total billed charges","45% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.76,65,,81.41,,,0,"percent of total billed charges","65% of total billed charges",69.04,27,,55.23,,,0,"percent of total billed charges","27% of total billed charges",148.73,95,,118.98,,,0,"percent of total billed charges","95% of total billed charges",156.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",137.77,88,,110.22,,,0,"percent of total billed charges","88% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",69.04,156.56,
"SILVADENE CREAM JAR 400G",2700000234,CDM,250,RC,,,Outpatient,,,156.56,78.28,,156.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",118.99,76,,95.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",117.42,75,,93.94,,,0,"percent of total billed charges","75% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",93.94,60,,75.15,,,0,"percent of total billed charges","60% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",70.45,45,,56.36,,,0,"percent of total billed charges","45% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.76,65,,81.41,,,0,"percent of total billed charges","65% of total billed charges",69.04,27,,55.23,,,0,"percent of total billed charges","27% of total billed charges",148.73,95,,118.98,,,0,"percent of total billed charges","95% of total billed charges",156.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",137.77,88,,110.22,,,0,"percent of total billed charges","88% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",69.04,156.56,
"SILVADENE CREAM TUBE 25G",2700000237,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"SILVADENE CREAM TUBE 25G",2700000238,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"SINEQUAN 10MG TAB",2700000241,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SINEQUAN 10MG TAB",2700000242,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SINEMET 10/100 TAB",2700000245,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"SINEMET 10/100 TAB",2700000246,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"SINEMET 25/100 TAB",2700000249,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"SINEMET 25/100 TAB",2700000250,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"SINEMET 25/250 TAB",2700000253,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"SINEMET 25/250 TAB",2700000254,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"SOMA 350MG TAB",2700000257,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SOMA 350MG TAB",2709999999,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"STRESSTAB W/ZN TAB",2710000003,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"STRESSTAB W/ZN TAB",2710000004,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SUMYCIN 250MG CAPS",2710000007,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SUMYCIN 250MG CAPS",2710000008,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SYNTHROID 25MCG TAB",2710000011,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SYNTHROID 25MCG TAB",2710000012,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"TENORMIN 50MG TAB",2710000015,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TENORMIN 50MG TAB",2710000016,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TESSALON 100MG CAP",2710000019,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"TESSALON 100MG CAP",2710000020,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"THERAGRAN M TAB",2710000023,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"THERAGRAN M TAB",2710000024,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"THORAZINE 25MG TAB",2710000027,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"THORAZINE 25MG TAB",2710000028,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"THYROID 1GR TAB",2710000031,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"THYROID 1GR TAB",2710000032,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SUDAFED TAB 30MG",2710000035,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SUDAFED TAB 30MG",2710000036,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SURFAK 240MG CAP",2710000039,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SURFAK 240MG CAP",2710000040,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SYMMETREL 100MG TAB",2710000043,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"SYMMETREL 100MG TAB",2710000044,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"SYNTHROID 0.1MG CAP",2710000047,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SYNTHROID 0.1MG CAP",2710000048,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SYNTHROID 0.15MG TAB",2710000051,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"SYNTHROID 0.15MG TAB",2710000052,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"SLOWMAG TAB",2710000055,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SLOWMAG TAB",2710000056,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HUMIBID LA TAB",2710000059,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"HUMIBID LA TAB",2710000060,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TOPROL XL 50MG TAB",2710000063,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TOPROL XL 50MG TAB",2710000064,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TOPROL XL 100MG TAB",2710000067,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TOPROL XL 100MG TAB",2710000068,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ULTRAM 50MG TAB",2710000071,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ULTRAM 50MG TAB",2710000072,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"FOSAMAX 10MG TAB",2710000075,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"FOSAMAX 10MG TAB",2710000077,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"TEARS NATURALE 15ML OPHTH SOLN",2710000080,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"TEARS NATURALE 15ML OPHTH SOLN",2710000081,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"GLUCOPHAGE 500MG TAB",2710000085,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLUCOPHAGE 500MG TAB",2710000086,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ZINC 220MG TAB",2710000089,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ZINC 220MG TAB",2710000090,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DEPAKOTE 250MG TAB",2710000093,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DEPAKOTE 250MG TAB",2710000094,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SINEMET 50/200CR TAB",2710000097,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"SINEMET 50/200CR TAB",2710000098,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"RISPERDOL 1MG TAB",2710000101,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"RISPERDOL 1MG TAB",2710000102,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"TEGRETOL 200MG TAB",2710000105,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"TEGRETOL 200MG TAB",2710000106,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"THIAMINE 100MG TAB",2710000109,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"THIAMINE 100MG TAB",2710000110,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TIMOPTIC .25% 5ML OPHTH SOLN",2710000113,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"TIMOPTIC .25% 5ML OPHTH SOLN",2710000114,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"TIMOPTIC 0.5% 5ML OPHTH SOLN",2710000117,CDM,250,RC,,,Outpatient,,,206.17,103.085,,206.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",156.69,76,,125.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",148.44,72,,118.75,,,0,"percent of total billed charges","72% of total billed charges",154.63,75,,123.70,,,0,"percent of total billed charges","75% of total billed charges",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",148.44,72,,118.75,,,0,"percent of total billed charges","72% of total billed charges",123.7,60,,98.96,,,0,"percent of total billed charges","60% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",92.78,45,,74.22,,,0,"percent of total billed charges","45% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",206.17,100,,,,,0,"fee schedule","100% CMS fee schedule",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",134.01,65,,107.21,,,0,"percent of total billed charges","65% of total billed charges",90.92,27,,72.74,,,0,"percent of total billed charges","27% of total billed charges",195.86,95,,156.69,,,0,"percent of total billed charges","95% of total billed charges",206.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",181.43,88,,145.14,,,0,"percent of total billed charges","88% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",90.92,206.17,
"TIMOPTIC 0.5% 5ML OPHTH SOLN",2710000118,CDM,250,RC,,,Outpatient,,,206.17,103.085,,206.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",156.69,76,,125.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",148.44,72,,118.75,,,0,"percent of total billed charges","72% of total billed charges",154.63,75,,123.70,,,0,"percent of total billed charges","75% of total billed charges",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",148.44,72,,118.75,,,0,"percent of total billed charges","72% of total billed charges",123.7,60,,98.96,,,0,"percent of total billed charges","60% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",92.78,45,,74.22,,,0,"percent of total billed charges","45% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",206.17,100,,,,,0,"fee schedule","100% CMS fee schedule",206.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",134.01,65,,107.21,,,0,"percent of total billed charges","65% of total billed charges",90.92,27,,72.74,,,0,"percent of total billed charges","27% of total billed charges",195.86,95,,156.69,,,0,"percent of total billed charges","95% of total billed charges",206.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",181.43,88,,145.14,,,0,"percent of total billed charges","88% of total billed charges",185.55,90,,148.44,,,0,"percent of total billed charges","90% of total billed charges",90.92,206.17,
"TRUSOPT OPHTH SOLN",2710000121,CDM,250,RC,,,Outpatient,,,169.79,84.895,,169.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",129.04,76,,103.23,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",122.25,72,,97.80,,,0,"percent of total billed charges","72% of total billed charges",127.34,75,,101.87,,,0,"percent of total billed charges","75% of total billed charges",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",122.25,72,,97.80,,,0,"percent of total billed charges","72% of total billed charges",101.87,60,,81.50,,,0,"percent of total billed charges","60% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",76.41,45,,61.13,,,0,"percent of total billed charges","45% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.79,100,,,,,0,"fee schedule","100% CMS fee schedule",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.36,65,,88.29,,,0,"percent of total billed charges","65% of total billed charges",74.88,27,,59.90,,,0,"percent of total billed charges","27% of total billed charges",161.3,95,,129.04,,,0,"percent of total billed charges","95% of total billed charges",169.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",149.42,88,,119.54,,,0,"percent of total billed charges","88% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",74.88,169.79,
"TRUSOPT OPHTH SOLN",2710000122,CDM,250,RC,,,Outpatient,,,169.79,84.895,,169.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",129.04,76,,103.23,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",122.25,72,,97.80,,,0,"percent of total billed charges","72% of total billed charges",127.34,75,,101.87,,,0,"percent of total billed charges","75% of total billed charges",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",122.25,72,,97.80,,,0,"percent of total billed charges","72% of total billed charges",101.87,60,,81.50,,,0,"percent of total billed charges","60% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",76.41,45,,61.13,,,0,"percent of total billed charges","45% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.79,100,,,,,0,"fee schedule","100% CMS fee schedule",169.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",110.36,65,,88.29,,,0,"percent of total billed charges","65% of total billed charges",74.88,27,,59.90,,,0,"percent of total billed charges","27% of total billed charges",161.3,95,,129.04,,,0,"percent of total billed charges","95% of total billed charges",169.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",149.42,88,,119.54,,,0,"percent of total billed charges","88% of total billed charges",152.81,90,,122.25,,,0,"percent of total billed charges","90% of total billed charges",74.88,169.79,
"TOBRADEX OPHTH SUSP",2710000125,CDM,250,RC,,,Outpatient,,,269.01,134.505,,269.01,125,,,,,0,"fee schedule","125% of CMS fee schedule",204.45,76,,163.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",193.69,72,,154.95,,,0,"percent of total billed charges","72% of total billed charges",201.76,75,,161.41,,,0,"percent of total billed charges","75% of total billed charges",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",193.69,72,,154.95,,,0,"percent of total billed charges","72% of total billed charges",161.41,60,,129.13,,,0,"percent of total billed charges","60% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",121.05,45,,96.84,,,0,"percent of total billed charges","45% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",269.01,100,,,,,0,"fee schedule","100% CMS fee schedule",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.86,65,,139.89,,,0,"percent of total billed charges","65% of total billed charges",118.63,27,,94.90,,,0,"percent of total billed charges","27% of total billed charges",255.56,95,,204.45,,,0,"percent of total billed charges","95% of total billed charges",269.01,75,,,,,0,"fee schedule","75% of CMS fee schedule",236.73,88,,189.38,,,0,"percent of total billed charges","88% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",118.63,269.01,
"TOBRADEX OPHTH SUSP",2710000126,CDM,250,RC,,,Outpatient,,,269.01,134.505,,269.01,125,,,,,0,"fee schedule","125% of CMS fee schedule",204.45,76,,163.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",193.69,72,,154.95,,,0,"percent of total billed charges","72% of total billed charges",201.76,75,,161.41,,,0,"percent of total billed charges","75% of total billed charges",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",193.69,72,,154.95,,,0,"percent of total billed charges","72% of total billed charges",161.41,60,,129.13,,,0,"percent of total billed charges","60% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",121.05,45,,96.84,,,0,"percent of total billed charges","45% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",269.01,100,,,,,0,"fee schedule","100% CMS fee schedule",269.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.86,65,,139.89,,,0,"percent of total billed charges","65% of total billed charges",118.63,27,,94.90,,,0,"percent of total billed charges","27% of total billed charges",255.56,95,,204.45,,,0,"percent of total billed charges","95% of total billed charges",269.01,75,,,,,0,"fee schedule","75% of CMS fee schedule",236.73,88,,189.38,,,0,"percent of total billed charges","88% of total billed charges",242.11,90,,193.69,,,0,"percent of total billed charges","90% of total billed charges",118.63,269.01,
"TOBREX OPTH 0.3% 5ML OINT",2710000129,CDM,250,RC,,,Outpatient,,,158.76,79.38,,158.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",120.66,76,,96.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",119.07,75,,95.26,,,0,"percent of total billed charges","75% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",95.26,60,,76.21,,,0,"percent of total billed charges","60% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",71.44,45,,57.15,,,0,"percent of total billed charges","45% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.19,65,,82.55,,,0,"percent of total billed charges","65% of total billed charges",70.01,27,,56.01,,,0,"percent of total billed charges","27% of total billed charges",150.82,95,,120.66,,,0,"percent of total billed charges","95% of total billed charges",158.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",139.71,88,,111.77,,,0,"percent of total billed charges","88% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",70.01,158.76,
"TOBREX OPTH 0.3% 5ML OINT",2710000130,CDM,250,RC,,,Outpatient,,,158.76,79.38,,158.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",120.66,76,,96.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",119.07,75,,95.26,,,0,"percent of total billed charges","75% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.31,72,,91.45,,,0,"percent of total billed charges","72% of total billed charges",95.26,60,,76.21,,,0,"percent of total billed charges","60% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",71.44,45,,57.15,,,0,"percent of total billed charges","45% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% CMS fee schedule",158.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.19,65,,82.55,,,0,"percent of total billed charges","65% of total billed charges",70.01,27,,56.01,,,0,"percent of total billed charges","27% of total billed charges",150.82,95,,120.66,,,0,"percent of total billed charges","95% of total billed charges",158.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",139.71,88,,111.77,,,0,"percent of total billed charges","88% of total billed charges",142.88,90,,114.30,,,0,"percent of total billed charges","90% of total billed charges",70.01,158.76,
"TOFRANIL 25MG TAB",2710000133,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TOFRANIL 25MG TAB",2710000134,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TOPAMAX XL 100MG TAB",2710000137,CDM,250,RC,,,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"TOPAMAX XL 100MG TAB",2710000138,CDM,250,RC,,,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"TRANSDERMNITRO 0.2MG/HR PATCH",2710000141,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"TRANSDERMNITRO 0.2MG/HR PATCH",2710000142,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"TRANSDERM NITRO 0.4MG/HR PATCH",2710000145,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"TRANSDERM NITRO 0.4MG/HR PATCH",2710000146,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"TRANXENE 3.75MG CAP",2710000149,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"TRANXENE 3.75MG CAP",2710000150,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"TRENTAL 400MG TAB",2710000153,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TRENTAL 400MG TAB",2710000154,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TRANSDERM NITRO 0.6MG/HR PATCH",2710000157,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"TRANSDERM NITRO 0.6MG/HR PATCH",2710000158,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"TUSSIONEX SUSP UD 5ML",2710000161,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TUSSIONEX SUSP UD 5ML",2710000162,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TYLENOL 325MG TAB",2710000165,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL 325MG TAB",2710000166,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL 500MG TAB",2710000169,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL 500MG TAB",2710000170,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL W/CODEINE #3 TAB",2710000173,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL W/CODEINE #3 TAB",2710000174,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"JANUVIA 50MG TAB",2710000177,CDM,250,RC,,,Outpatient,,,42.75,21.375,,42.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.49,76,,25.99,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.78,72,,24.62,,,0,"percent of total billed charges","72% of total billed charges",32.06,75,,25.65,,,0,"percent of total billed charges","75% of total billed charges",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.78,72,,24.62,,,0,"percent of total billed charges","72% of total billed charges",25.65,60,,20.52,,,0,"percent of total billed charges","60% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",19.24,45,,15.39,,,0,"percent of total billed charges","45% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.75,100,,,,,0,"fee schedule","100% CMS fee schedule",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.79,65,,22.23,,,0,"percent of total billed charges","65% of total billed charges",18.85,27,,15.08,,,0,"percent of total billed charges","27% of total billed charges",40.61,95,,32.49,,,0,"percent of total billed charges","95% of total billed charges",42.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.62,88,,30.10,,,0,"percent of total billed charges","88% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",18.85,42.75,
"JANUVIA 50MG TAB",2710000178,CDM,250,RC,,,Outpatient,,,42.75,21.375,,42.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.49,76,,25.99,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.78,72,,24.62,,,0,"percent of total billed charges","72% of total billed charges",32.06,75,,25.65,,,0,"percent of total billed charges","75% of total billed charges",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.78,72,,24.62,,,0,"percent of total billed charges","72% of total billed charges",25.65,60,,20.52,,,0,"percent of total billed charges","60% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",19.24,45,,15.39,,,0,"percent of total billed charges","45% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.75,100,,,,,0,"fee schedule","100% CMS fee schedule",42.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.79,65,,22.23,,,0,"percent of total billed charges","65% of total billed charges",18.85,27,,15.08,,,0,"percent of total billed charges","27% of total billed charges",40.61,95,,32.49,,,0,"percent of total billed charges","95% of total billed charges",42.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.62,88,,30.10,,,0,"percent of total billed charges","88% of total billed charges",38.48,90,,30.78,,,0,"percent of total billed charges","90% of total billed charges",18.85,42.75,
"URECHOLINE 25MG TAB",2710000181,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"URECHOLINE 25MG TAB",2710000182,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"VALIUM 2MG TAB",2710000185,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VALIUM 2MG TAB",2710000186,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VALIUM 5MG TAB",2710000189,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VALIUM 5MG TAB",2710000190,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VICODIN TAB",2710000193,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VICODIN TAB",2710000194,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VIBRAMYCIN 100MG CAP",2710000197,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"VIBRAMYCIN 100MG CAP",2710000198,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"XALATAN OPHT SOL",2710000201,CDM,250,RC,,,Outpatient,,,464.15,232.075,,464.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",352.75,76,,282.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",348.11,75,,278.49,,,0,"percent of total billed charges","75% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",278.49,60,,222.79,,,0,"percent of total billed charges","60% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",208.87,45,,167.10,,,0,"percent of total billed charges","45% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",301.7,65,,241.36,,,0,"percent of total billed charges","65% of total billed charges",204.69,27,,163.75,,,0,"percent of total billed charges","27% of total billed charges",440.94,95,,352.75,,,0,"percent of total billed charges","95% of total billed charges",464.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",408.45,88,,326.76,,,0,"percent of total billed charges","88% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",204.69,464.15,
"XALATAN OPHT SOL",2710000202,CDM,250,RC,,,Outpatient,,,464.15,232.075,,464.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",352.75,76,,282.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",348.11,75,,278.49,,,0,"percent of total billed charges","75% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.19,72,,267.35,,,0,"percent of total billed charges","72% of total billed charges",278.49,60,,222.79,,,0,"percent of total billed charges","60% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",208.87,45,,167.10,,,0,"percent of total billed charges","45% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% CMS fee schedule",464.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",301.7,65,,241.36,,,0,"percent of total billed charges","65% of total billed charges",204.69,27,,163.75,,,0,"percent of total billed charges","27% of total billed charges",440.94,95,,352.75,,,0,"percent of total billed charges","95% of total billed charges",464.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",408.45,88,,326.76,,,0,"percent of total billed charges","88% of total billed charges",417.74,90,,334.19,,,0,"percent of total billed charges","90% of total billed charges",204.69,464.15,
"XANAX 0.25MG TAB",2710000205,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"XANAX 0.25MG TAB",2710000206,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"XANAX 0.5MG TAB",2710000209,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"XANAX 0.5MG TAB",2710000210,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"XANAX 1MG TAB",2710000213,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"XANAX 1MG TAB",2710000214,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"XYLOCAINE JELLY 2% 5ML",2710000217,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"XYLOCAINE JELLY 2% 5ML",2710000218,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"XYLOCAIN JEL 2% 30CC",2710000221,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"XYLOCAIN JEL 2% 30CC",2710000222,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"ZANTAC 150MG TAB",2710000225,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ZANTAC 150MG TAB",2710000226,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"ZAROXOLYN 5MG TAB",2710000229,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ZAROXOLYN 5MG TAB",2710000230,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ZOLOFT 50MG TAB",2710000233,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ZOLOFT 50MG TAB",2710000234,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ZOFRAN 4MG TAB",2710000237,CDM,250,RC,,,Outpatient,,,95.92,47.96,,95.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",72.9,76,,58.32,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",69.06,72,,55.25,,,0,"percent of total billed charges","72% of total billed charges",71.94,75,,57.55,,,0,"percent of total billed charges","75% of total billed charges",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.06,72,,55.25,,,0,"percent of total billed charges","72% of total billed charges",57.55,60,,46.04,,,0,"percent of total billed charges","60% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",43.16,45,,34.53,,,0,"percent of total billed charges","45% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.92,100,,,,,0,"fee schedule","100% CMS fee schedule",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.35,65,,49.88,,,0,"percent of total billed charges","65% of total billed charges",42.3,27,,33.84,,,0,"percent of total billed charges","27% of total billed charges",91.12,95,,72.90,,,0,"percent of total billed charges","95% of total billed charges",95.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",84.41,88,,67.53,,,0,"percent of total billed charges","88% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",42.3,95.92,
"ZOFRAN 4MG TAB",2710000238,CDM,250,RC,,,Outpatient,,,95.92,47.96,,95.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",72.9,76,,58.32,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",69.06,72,,55.25,,,0,"percent of total billed charges","72% of total billed charges",71.94,75,,57.55,,,0,"percent of total billed charges","75% of total billed charges",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.06,72,,55.25,,,0,"percent of total billed charges","72% of total billed charges",57.55,60,,46.04,,,0,"percent of total billed charges","60% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",43.16,45,,34.53,,,0,"percent of total billed charges","45% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.92,100,,,,,0,"fee schedule","100% CMS fee schedule",95.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.35,65,,49.88,,,0,"percent of total billed charges","65% of total billed charges",42.3,27,,33.84,,,0,"percent of total billed charges","27% of total billed charges",91.12,95,,72.90,,,0,"percent of total billed charges","95% of total billed charges",95.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",84.41,88,,67.53,,,0,"percent of total billed charges","88% of total billed charges",86.33,90,,69.06,,,0,"percent of total billed charges","90% of total billed charges",42.3,95.92,
"ZYLOPRIM 100MG TAB",2710000241,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ZYLOPRIM 100MG TAB",2710000242,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ZYLOPRIM 300MG TAB",2710000245,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ZYLOPRIM 300MG TAB",2710000246,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ZYRETEC 10MG TAB",2710000249,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"ZYRETEC 10MG TAB",2710000250,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"ACTIDOSEAQUA 120ML",2710000253,CDM,250,RC,,,Outpatient,,,63.95,31.975,,63.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",48.6,76,,38.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",47.96,75,,38.37,,,0,"percent of total billed charges","75% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",38.37,60,,30.70,,,0,"percent of total billed charges","60% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.78,45,,23.02,,,0,"percent of total billed charges","45% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.57,65,,33.26,,,0,"percent of total billed charges","65% of total billed charges",28.2,27,,22.56,,,0,"percent of total billed charges","27% of total billed charges",60.75,95,,48.60,,,0,"percent of total billed charges","95% of total billed charges",63.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",56.28,88,,45.02,,,0,"percent of total billed charges","88% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.2,63.95,
"ACTIDOSEAQUA 120ML",2710000254,CDM,250,RC,,,Outpatient,,,63.95,31.975,,63.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",48.6,76,,38.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",47.96,75,,38.37,,,0,"percent of total billed charges","75% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",38.37,60,,30.70,,,0,"percent of total billed charges","60% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.78,45,,23.02,,,0,"percent of total billed charges","45% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.57,65,,33.26,,,0,"percent of total billed charges","65% of total billed charges",28.2,27,,22.56,,,0,"percent of total billed charges","27% of total billed charges",60.75,95,,48.60,,,0,"percent of total billed charges","95% of total billed charges",63.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",56.28,88,,45.02,,,0,"percent of total billed charges","88% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.2,63.95,
"CLOTRIMAZOLE 1% CREAM",2710000257,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"CLOTRIMAZOLE 1% CREAM",2710000258,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"ZOCOR 10MG TAB",2710000261,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ZOCOR 10MG TAB",2710000262,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"NEOSYNEPHRINE 1% NASAL SOLN",2710000265,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"NEOSYNEPHRINE 1% NASAL SOLN",2710000266,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"COUMADIN 2.5MG TAB",2710000269,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"COUMADIN 2.5MG TAB",2710000270,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"BUMEX 1MG TAB",2710000273,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"BUMEX 1MG TAB",2710000274,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"FLAGYL 500MG TAB",2710000277,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"FLAGYL 500MG TAB",2710000278,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"THEOPHYLL 200MG TAB",2710000281,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"THEOPHYLL 200MG TAB",2710000282,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LANOLIN OINT",2710000285,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"LANOLIN OINT",2710000286,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"SILVER NITRATE 1GM",2710000289,CDM,250,RC,,,Outpatient,,,94.82,47.41,,94.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",72.06,76,,57.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",68.27,72,,54.62,,,0,"percent of total billed charges","72% of total billed charges",71.12,75,,56.90,,,0,"percent of total billed charges","75% of total billed charges",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.27,72,,54.62,,,0,"percent of total billed charges","72% of total billed charges",56.89,60,,45.51,,,0,"percent of total billed charges","60% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",42.67,45,,34.14,,,0,"percent of total billed charges","45% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.82,100,,,,,0,"fee schedule","100% CMS fee schedule",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.63,65,,49.30,,,0,"percent of total billed charges","65% of total billed charges",41.82,27,,33.46,,,0,"percent of total billed charges","27% of total billed charges",90.08,95,,72.06,,,0,"percent of total billed charges","95% of total billed charges",94.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",83.44,88,,66.75,,,0,"percent of total billed charges","88% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",41.82,94.82,
"SILVER NITRATE 1GM",2710000290,CDM,250,RC,,,Outpatient,,,94.82,47.41,,94.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",72.06,76,,57.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",68.27,72,,54.62,,,0,"percent of total billed charges","72% of total billed charges",71.12,75,,56.90,,,0,"percent of total billed charges","75% of total billed charges",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.27,72,,54.62,,,0,"percent of total billed charges","72% of total billed charges",56.89,60,,45.51,,,0,"percent of total billed charges","60% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",42.67,45,,34.14,,,0,"percent of total billed charges","45% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",94.82,100,,,,,0,"fee schedule","100% CMS fee schedule",94.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.63,65,,49.30,,,0,"percent of total billed charges","65% of total billed charges",41.82,27,,33.46,,,0,"percent of total billed charges","27% of total billed charges",90.08,95,,72.06,,,0,"percent of total billed charges","95% of total billed charges",94.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",83.44,88,,66.75,,,0,"percent of total billed charges","88% of total billed charges",85.34,90,,68.27,,,0,"percent of total billed charges","90% of total billed charges",41.82,94.82,
"CATAPRESS TTS1 PATCH",2710000293,CDM,250,RC,,,Outpatient,,,251.37,125.685,,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",188.53,75,,150.82,,,0,"percent of total billed charges","75% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",150.82,60,,120.66,,,0,"percent of total billed charges","60% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,176.97,,,0,"percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",110.85,251.37,
"CATAPRESS TTS1 PATCH",2710000294,CDM,250,RC,,,Outpatient,,,251.37,125.685,,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",188.53,75,,150.82,,,0,"percent of total billed charges","75% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",150.82,60,,120.66,,,0,"percent of total billed charges","60% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,176.97,,,0,"percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",110.85,251.37,
"PERCOCET TAB",2710000297,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PERCOCET TAB",2710000298,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"VASOTEC 5MG TAB",2710000301,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"VASOTEC 5MG TAB",2710000302,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"DIMETANE DX",2710000305,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DIMETANE DX",2710000306,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"RONDEC DROPS 30ML",2710000309,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"RONDEC DROPS 30ML",2710000310,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CATAPRESS TTS2 PATCH",2710000317,CDM,250,RC,,,Outpatient,,,276.73,138.365,,276.73,125,,,,,0,"fee schedule","125% of CMS fee schedule",210.31,76,,168.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",199.25,72,,159.40,,,0,"percent of total billed charges","72% of total billed charges",207.55,75,,166.04,,,0,"percent of total billed charges","75% of total billed charges",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.25,72,,159.40,,,0,"percent of total billed charges","72% of total billed charges",166.04,60,,132.83,,,0,"percent of total billed charges","60% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",124.53,45,,99.62,,,0,"percent of total billed charges","45% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.73,100,,,,,0,"fee schedule","100% CMS fee schedule",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.87,65,,143.90,,,0,"percent of total billed charges","65% of total billed charges",122.04,27,,97.63,,,0,"percent of total billed charges","27% of total billed charges",262.89,95,,210.31,,,0,"percent of total billed charges","95% of total billed charges",276.73,75,,,,,0,"fee schedule","75% of CMS fee schedule",243.52,88,,194.82,,,0,"percent of total billed charges","88% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",122.04,276.73,
"CATAPRESS TTS2 PATCH",2710000318,CDM,250,RC,,,Outpatient,,,276.73,138.365,,276.73,125,,,,,0,"fee schedule","125% of CMS fee schedule",210.31,76,,168.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",199.25,72,,159.40,,,0,"percent of total billed charges","72% of total billed charges",207.55,75,,166.04,,,0,"percent of total billed charges","75% of total billed charges",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.25,72,,159.40,,,0,"percent of total billed charges","72% of total billed charges",166.04,60,,132.83,,,0,"percent of total billed charges","60% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",124.53,45,,99.62,,,0,"percent of total billed charges","45% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.73,100,,,,,0,"fee schedule","100% CMS fee schedule",276.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.87,65,,143.90,,,0,"percent of total billed charges","65% of total billed charges",122.04,27,,97.63,,,0,"percent of total billed charges","27% of total billed charges",262.89,95,,210.31,,,0,"percent of total billed charges","95% of total billed charges",276.73,75,,,,,0,"fee schedule","75% of CMS fee schedule",243.52,88,,194.82,,,0,"percent of total billed charges","88% of total billed charges",249.06,90,,199.25,,,0,"percent of total billed charges","90% of total billed charges",122.04,276.73,
"CATAPRESS TTS3 PATCH",2710000321,CDM,250,RC,,,Outpatient,,,383.67,191.835,,383.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",291.59,76,,233.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",276.24,72,,220.99,,,0,"percent of total billed charges","72% of total billed charges",287.75,75,,230.20,,,0,"percent of total billed charges","75% of total billed charges",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.24,72,,220.99,,,0,"percent of total billed charges","72% of total billed charges",230.2,60,,184.16,,,0,"percent of total billed charges","60% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",172.65,45,,138.12,,,0,"percent of total billed charges","45% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",383.67,100,,,,,0,"fee schedule","100% CMS fee schedule",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",249.39,65,,199.51,,,0,"percent of total billed charges","65% of total billed charges",169.2,27,,135.36,,,0,"percent of total billed charges","27% of total billed charges",364.49,95,,291.59,,,0,"percent of total billed charges","95% of total billed charges",383.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",337.63,88,,270.10,,,0,"percent of total billed charges","88% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",169.2,383.67,
"CATAPRESS TTS3 PATCH",2710000322,CDM,250,RC,,,Outpatient,,,383.67,191.835,,383.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",291.59,76,,233.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",276.24,72,,220.99,,,0,"percent of total billed charges","72% of total billed charges",287.75,75,,230.20,,,0,"percent of total billed charges","75% of total billed charges",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.24,72,,220.99,,,0,"percent of total billed charges","72% of total billed charges",230.2,60,,184.16,,,0,"percent of total billed charges","60% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",172.65,45,,138.12,,,0,"percent of total billed charges","45% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",383.67,100,,,,,0,"fee schedule","100% CMS fee schedule",383.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",249.39,65,,199.51,,,0,"percent of total billed charges","65% of total billed charges",169.2,27,,135.36,,,0,"percent of total billed charges","27% of total billed charges",364.49,95,,291.59,,,0,"percent of total billed charges","95% of total billed charges",383.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",337.63,88,,270.10,,,0,"percent of total billed charges","88% of total billed charges",345.3,90,,276.24,,,0,"percent of total billed charges","90% of total billed charges",169.2,383.67,
"ATIVAN 05MG TAB",2710000325,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ATIVAN 05MG TAB",2710000326,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"LOPID 600MG TAB",2710000329,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"LOPID 600MG TAB",2710000330,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CALAN SR 240MG TAB",2710000333,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"CALAN SR 240MG TAB",2710000334,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BUSPAR 10MG TAB",2710000337,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BUSPAR 10MG TAB",2710000338,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ROCALTROL 0.25MCG CAP",2710000341,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ROCALTROL 0.25MCG CAP",2710000342,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"DEEP SEA NASAL SPRAY 45ML",2710000345,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"DEEP SEA NASAL SPRAY 45ML",2710000346,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"MICROK 10 CAP",2710000349,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"MICROK 10 CAP",2710000350,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"CALAMINE LOT 60ML",2710000353,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"CALAMINE LOT 60ML",2710000354,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"AURO EAR SOLN 15ML",2710000357,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"AURO EAR SOLN 15ML",2710000358,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"LEVSIN 0.125MG TAB",2710000361,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LEVSIN 0.125MG TAB",2710000362,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"DEPAKENE 250/5 SUSP",2710000365,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"DEPAKENE 250/5 SUSP",2710000366,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PHENERGAN SUPP 25MG",2710000373,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"PHENERGAN SUPP 25MG",2710000374,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"IMODIUM LIQ 4OZ",2710000377,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"IMODIUM LIQ 4OZ",2710000378,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"MS CONTIN 30MG TAB",2710000381,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MS CONTIN 30MG TAB",2710000382,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MYCELEX TROCHE 10MG TAB",2710000385,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MYCELEX TROCHE 10MG TAB",2710000386,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ATROVENT INHALER",2710000389,CDM,250,RC,,,Outpatient,,,965.79,482.895,,965.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",734,76,,587.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",695.37,72,,556.30,,,0,"percent of total billed charges","72% of total billed charges",724.34,75,,579.47,,,0,"percent of total billed charges","75% of total billed charges",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",695.37,72,,556.30,,,0,"percent of total billed charges","72% of total billed charges",579.47,60,,463.58,,,0,"percent of total billed charges","60% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",434.61,45,,347.69,,,0,"percent of total billed charges","45% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",965.79,100,,,,,0,"fee schedule","100% CMS fee schedule",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",627.76,65,,502.21,,,0,"percent of total billed charges","65% of total billed charges",425.91,27,,340.73,,,0,"percent of total billed charges","27% of total billed charges",917.5,95,,734.00,,,0,"percent of total billed charges","95% of total billed charges",965.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",849.9,88,,679.92,,,0,"percent of total billed charges","88% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",425.91,965.79,
"ATROVENT INHALER",2710000390,CDM,250,RC,,,Outpatient,,,965.79,482.895,,965.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",734,76,,587.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",695.37,72,,556.30,,,0,"percent of total billed charges","72% of total billed charges",724.34,75,,579.47,,,0,"percent of total billed charges","75% of total billed charges",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",695.37,72,,556.30,,,0,"percent of total billed charges","72% of total billed charges",579.47,60,,463.58,,,0,"percent of total billed charges","60% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",434.61,45,,347.69,,,0,"percent of total billed charges","45% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",965.79,100,,,,,0,"fee schedule","100% CMS fee schedule",965.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",627.76,65,,502.21,,,0,"percent of total billed charges","65% of total billed charges",425.91,27,,340.73,,,0,"percent of total billed charges","27% of total billed charges",917.5,95,,734.00,,,0,"percent of total billed charges","95% of total billed charges",965.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",849.9,88,,679.92,,,0,"percent of total billed charges","88% of total billed charges",869.21,90,,695.37,,,0,"percent of total billed charges","90% of total billed charges",425.91,965.79,
"MOTRIN 200MG TAB",2710000393,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MOTRIN 200MG TAB",2710000394,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SORBITOL 70% 2OZ",2720000001,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"SORBITOL 70% 2OZ",2720000002,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MARINOL 2.5MG CAP",2720000005,CDM,250,RC,,,Outpatient,,,23.15,11.575,,23.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.59,76,,14.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",17.36,75,,13.89,,,0,"percent of total billed charges","75% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",13.89,60,,11.11,,,0,"percent of total billed charges","60% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.42,45,,8.34,,,0,"percent of total billed charges","45% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,65,,12.04,,,0,"percent of total billed charges","65% of total billed charges",10.21,27,,8.17,,,0,"percent of total billed charges","27% of total billed charges",21.99,95,,17.59,,,0,"percent of total billed charges","95% of total billed charges",23.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.37,88,,16.30,,,0,"percent of total billed charges","88% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.21,23.15,
"MARINOL 2.5MG CAP",2720000006,CDM,250,RC,,,Outpatient,,,23.15,11.575,,23.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.59,76,,14.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",17.36,75,,13.89,,,0,"percent of total billed charges","75% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",13.89,60,,11.11,,,0,"percent of total billed charges","60% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.42,45,,8.34,,,0,"percent of total billed charges","45% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,65,,12.04,,,0,"percent of total billed charges","65% of total billed charges",10.21,27,,8.17,,,0,"percent of total billed charges","27% of total billed charges",21.99,95,,17.59,,,0,"percent of total billed charges","95% of total billed charges",23.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.37,88,,16.30,,,0,"percent of total billed charges","88% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.21,23.15,
"TEGRETOL 100MG TAB",2720000009,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"TEGRETOL 100MG TAB",2720000010,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SYNTHOID 0.125MG TAB",2720000013,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SYNTHOID 0.125MG TAB",2720000014,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GLYCERIN PEDI SUPP",2720000017,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GLYCERIN PEDI SUPP",2720000018,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"RYTHMOL 150MG TAB",2720000021,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"RYTHMOL 150MG TAB",2720000022,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LEVOTHROID 50MCG TAB",2720000025,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LEVOTHROID 50MCG TAB",2720000026,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PROZAC 20MG CAP",2720000029,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PROZAC 20MG CAP",2720000030,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"SYNTHROID 0.112 MG TAB",2720000033,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SYNTHROID 0.112 MG TAB",2720000034,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"EUCERIN CREAM 30GM",2720000037,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"EUCERIN CREAM 30GM",2720000038,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"CETACAINE SPRAY",2720000041,CDM,250,RC,,,Outpatient,,,285.55,142.775,,285.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",217.02,76,,173.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",214.16,75,,171.33,,,0,"percent of total billed charges","75% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",171.33,60,,137.06,,,0,"percent of total billed charges","60% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",128.5,45,,102.80,,,0,"percent of total billed charges","45% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",185.61,65,,148.49,,,0,"percent of total billed charges","65% of total billed charges",125.93,27,,100.74,,,0,"percent of total billed charges","27% of total billed charges",271.27,95,,217.02,,,0,"percent of total billed charges","95% of total billed charges",285.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",251.28,88,,201.02,,,0,"percent of total billed charges","88% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",125.93,285.55,
"CETACAINE SPRAY",2720000042,CDM,250,RC,,,Outpatient,,,285.55,142.775,,285.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",217.02,76,,173.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",214.16,75,,171.33,,,0,"percent of total billed charges","75% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",171.33,60,,137.06,,,0,"percent of total billed charges","60% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",128.5,45,,102.80,,,0,"percent of total billed charges","45% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",185.61,65,,148.49,,,0,"percent of total billed charges","65% of total billed charges",125.93,27,,100.74,,,0,"percent of total billed charges","27% of total billed charges",271.27,95,,217.02,,,0,"percent of total billed charges","95% of total billed charges",285.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",251.28,88,,201.02,,,0,"percent of total billed charges","88% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",125.93,285.55,
"TUCKS MOISTENED PADS",2720000045,CDM,250,RC,,,Outpatient,,,23.15,11.575,,23.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.59,76,,14.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",17.36,75,,13.89,,,0,"percent of total billed charges","75% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",13.89,60,,11.11,,,0,"percent of total billed charges","60% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.42,45,,8.34,,,0,"percent of total billed charges","45% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,65,,12.04,,,0,"percent of total billed charges","65% of total billed charges",10.21,27,,8.17,,,0,"percent of total billed charges","27% of total billed charges",21.99,95,,17.59,,,0,"percent of total billed charges","95% of total billed charges",23.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.37,88,,16.30,,,0,"percent of total billed charges","88% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.21,23.15,
"TUCKS MOISTENED PADS",2720000046,CDM,250,RC,,,Outpatient,,,23.15,11.575,,23.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.59,76,,14.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",17.36,75,,13.89,,,0,"percent of total billed charges","75% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.67,72,,13.34,,,0,"percent of total billed charges","72% of total billed charges",13.89,60,,11.11,,,0,"percent of total billed charges","60% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.42,45,,8.34,,,0,"percent of total billed charges","45% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% CMS fee schedule",23.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.05,65,,12.04,,,0,"percent of total billed charges","65% of total billed charges",10.21,27,,8.17,,,0,"percent of total billed charges","27% of total billed charges",21.99,95,,17.59,,,0,"percent of total billed charges","95% of total billed charges",23.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.37,88,,16.30,,,0,"percent of total billed charges","88% of total billed charges",20.84,90,,16.67,,,0,"percent of total billed charges","90% of total billed charges",10.21,23.15,
"PACERONE 200MG TAB",2720000049,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PACERONE 200MG TAB",2720000050,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"KPHOS 500MG TAB",2720000053,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"KPHOS 500MG TAB",2720000054,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CARDIZEM SR 60 CAP",2720000057,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CARDIZEM SR 60 CAP",2720000058,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NEPTAZANE 50MG TAB",2720000061,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NEPTAZANE 50MG TAB",2720000062,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CEFTIN 250MG TAB",2720000065,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"CEFTIN 250MG TAB",2720000066,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"TEGRETOL SUSP 100MG/5ML",2720000069,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TEGRETOL SUSP 100MG/5ML",2720000070,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LACHYDRIN 12% 5OZ",2720000073,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"LACHYDRIN 12% 5OZ",2720000074,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"PRINIVIL 10MG TAB",2720000077,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PRINIVIL 10MG TAB",2720000078,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"HYDROXYUREA 500MG TAB",2720000081,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"HYDROXYUREA 500MG TAB",2720000082,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"KDUR 20MEQ TAB",2720000085,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"KDUR 20MEQ TAB",2720000086,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROVENTIL 3ML U/D NEB 2.5MG",2720000089,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PROVENTIL 3ML U/D NEB 2.5MG",2720000090,CDM,250,RC,J7613,HCPCS,Outpatient,,,4.41,2.205,U8,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.28,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.28,350,,0.07,0.06,0.08,"1 through 10","fee schedule","350% of BCBS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.28,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.08,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",3.97,90,,9.72,8.86,27.86,"1 through 10","percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,0.33,0.22,0.57,"1 through 10","fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,8.60,4.89,14.94,80,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,0.16,0.16,0.16,"1 through 10","fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",0.08,4.41,
"NEOSYNEPHRINE 2.5% OPHTH SOLN",2720000093,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"NEOSYNEPHRINE 2.5% OPHTH SOLN",2720000094,CDM,250,RC,,,Outpatient,,,91.51,45.755,,91.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.55,76,,55.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",68.63,75,,54.90,,,0,"percent of total billed charges","75% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.89,72,,52.71,,,0,"percent of total billed charges","72% of total billed charges",54.91,60,,43.93,,,0,"percent of total billed charges","60% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",41.18,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% CMS fee schedule",91.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.48,65,,47.58,,,0,"percent of total billed charges","65% of total billed charges",40.36,27,,32.29,,,0,"percent of total billed charges","27% of total billed charges",86.93,95,,69.54,,,0,"percent of total billed charges","95% of total billed charges",91.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",80.53,88,,64.42,,,0,"percent of total billed charges","88% of total billed charges",82.36,90,,65.89,,,0,"percent of total billed charges","90% of total billed charges",40.36,91.51,
"ROBITUSSIN 5CC",2720000097,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ROBITUSSIN 5CC",2720000098,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CIPRO 250MG TAB",2720000101,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"CIPRO 250MG TAB",2720000102,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"CIPRO 500MG TAB",2720000105,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"CIPRO 500MG TAB",2720000106,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"MIOSTAT OPHTH SOLN",2720000109,CDM,250,RC,,,Outpatient,,,138.92,69.46,,138.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",105.58,76,,84.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",100.02,72,,80.02,,,0,"percent of total billed charges","72% of total billed charges",104.19,75,,83.35,,,0,"percent of total billed charges","75% of total billed charges",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",100.02,72,,80.02,,,0,"percent of total billed charges","72% of total billed charges",83.35,60,,66.68,,,0,"percent of total billed charges","60% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",62.51,45,,50.01,,,0,"percent of total billed charges","45% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",138.92,100,,,,,0,"fee schedule","100% CMS fee schedule",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.3,65,,72.24,,,0,"percent of total billed charges","65% of total billed charges",61.26,27,,49.01,,,0,"percent of total billed charges","27% of total billed charges",131.97,95,,105.58,,,0,"percent of total billed charges","95% of total billed charges",138.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",122.25,88,,97.80,,,0,"percent of total billed charges","88% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",61.26,138.92,
"MIOSTAT OPHTH SOLN",2720000110,CDM,250,RC,,,Outpatient,,,138.92,69.46,,138.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",105.58,76,,84.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",100.02,72,,80.02,,,0,"percent of total billed charges","72% of total billed charges",104.19,75,,83.35,,,0,"percent of total billed charges","75% of total billed charges",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",100.02,72,,80.02,,,0,"percent of total billed charges","72% of total billed charges",83.35,60,,66.68,,,0,"percent of total billed charges","60% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",62.51,45,,50.01,,,0,"percent of total billed charges","45% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",138.92,100,,,,,0,"fee schedule","100% CMS fee schedule",138.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.3,65,,72.24,,,0,"percent of total billed charges","65% of total billed charges",61.26,27,,49.01,,,0,"percent of total billed charges","27% of total billed charges",131.97,95,,105.58,,,0,"percent of total billed charges","95% of total billed charges",138.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",122.25,88,,97.80,,,0,"percent of total billed charges","88% of total billed charges",125.03,90,,100.02,,,0,"percent of total billed charges","90% of total billed charges",61.26,138.92,
FLUORISTRIP,2720000113,CDM,250,RC,,,Outpatient,,,189.63,94.815,,189.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",144.12,76,,115.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",136.53,72,,109.22,,,0,"percent of total billed charges","72% of total billed charges",142.22,75,,113.78,,,0,"percent of total billed charges","75% of total billed charges",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",136.53,72,,109.22,,,0,"percent of total billed charges","72% of total billed charges",113.78,60,,91.02,,,0,"percent of total billed charges","60% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",85.33,45,,68.26,,,0,"percent of total billed charges","45% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.63,100,,,,,0,"fee schedule","100% CMS fee schedule",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.26,65,,98.61,,,0,"percent of total billed charges","65% of total billed charges",83.63,27,,66.90,,,0,"percent of total billed charges","27% of total billed charges",180.15,95,,144.12,,,0,"percent of total billed charges","95% of total billed charges",189.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",166.87,88,,133.50,,,0,"percent of total billed charges","88% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",83.63,189.63,
FLUORISTRIP,2720000114,CDM,250,RC,,,Outpatient,,,189.63,94.815,,189.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",144.12,76,,115.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",136.53,72,,109.22,,,0,"percent of total billed charges","72% of total billed charges",142.22,75,,113.78,,,0,"percent of total billed charges","75% of total billed charges",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",136.53,72,,109.22,,,0,"percent of total billed charges","72% of total billed charges",113.78,60,,91.02,,,0,"percent of total billed charges","60% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",85.33,45,,68.26,,,0,"percent of total billed charges","45% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.63,100,,,,,0,"fee schedule","100% CMS fee schedule",189.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.26,65,,98.61,,,0,"percent of total billed charges","65% of total billed charges",83.63,27,,66.90,,,0,"percent of total billed charges","27% of total billed charges",180.15,95,,144.12,,,0,"percent of total billed charges","95% of total billed charges",189.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",166.87,88,,133.50,,,0,"percent of total billed charges","88% of total billed charges",170.67,90,,136.54,,,0,"percent of total billed charges","90% of total billed charges",83.63,189.63,
"TORADOL 10MG TAB",2720000117,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"TORADOL 10MG TAB",2720000118,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PEPCID 20MG TAB",2720000121,CDM,250,RC,,,Outpatient,,,1.38,0.69,,1.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.05,76,,0.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.99,72,,0.79,,,0,"percent of total billed charges","72% of total billed charges",1.04,75,,0.83,,,0,"percent of total billed charges","75% of total billed charges",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.99,72,,0.79,,,0,"percent of total billed charges","72% of total billed charges",0.83,60,,0.66,,,0,"percent of total billed charges","60% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",0.62,45,,0.50,,,0,"percent of total billed charges","45% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.38,100,,,,,0,"fee schedule","100% CMS fee schedule",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.9,65,,0.72,,,0,"percent of total billed charges","65% of total billed charges",0.61,27,,0.49,,,0,"percent of total billed charges","27% of total billed charges",1.31,95,,1.05,,,0,"percent of total billed charges","95% of total billed charges",1.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.21,88,,0.97,,,0,"percent of total billed charges","88% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",0.61,1.38,
"PEPCID 20MG TAB",2720000122,CDM,250,RC,,,Outpatient,,,1.38,0.69,,1.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.05,76,,0.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.99,72,,0.79,,,0,"percent of total billed charges","72% of total billed charges",1.04,75,,0.83,,,0,"percent of total billed charges","75% of total billed charges",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.99,72,,0.79,,,0,"percent of total billed charges","72% of total billed charges",0.83,60,,0.66,,,0,"percent of total billed charges","60% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",0.62,45,,0.50,,,0,"percent of total billed charges","45% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.38,100,,,,,0,"fee schedule","100% CMS fee schedule",1.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.9,65,,0.72,,,0,"percent of total billed charges","65% of total billed charges",0.61,27,,0.49,,,0,"percent of total billed charges","27% of total billed charges",1.31,95,,1.05,,,0,"percent of total billed charges","95% of total billed charges",1.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.21,88,,0.97,,,0,"percent of total billed charges","88% of total billed charges",1.24,90,,0.99,,,0,"percent of total billed charges","90% of total billed charges",0.61,1.38,
"SILVADENE CREAM 400G",2720000125,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"SILVADENE CREAM 400G",2720000126,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"MUCOMYST 10% 4ML",2720000129,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"MUCOMYST 10% 4ML",2720000130,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"TERAZOL 7 VAG CREAM",2720000133,CDM,250,RC,,,Outpatient,,,181.91,90.955,,181.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",138.25,76,,110.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",136.43,75,,109.14,,,0,"percent of total billed charges","75% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",109.15,60,,87.32,,,0,"percent of total billed charges","60% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",81.86,45,,65.49,,,0,"percent of total billed charges","45% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.24,65,,94.59,,,0,"percent of total billed charges","65% of total billed charges",80.22,27,,64.18,,,0,"percent of total billed charges","27% of total billed charges",172.81,95,,138.25,,,0,"percent of total billed charges","95% of total billed charges",181.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",160.08,88,,128.06,,,0,"percent of total billed charges","88% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",80.22,181.91,
"TERAZOL 7 VAG CREAM",2720000134,CDM,250,RC,,,Outpatient,,,181.91,90.955,,181.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",138.25,76,,110.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",136.43,75,,109.14,,,0,"percent of total billed charges","75% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",109.15,60,,87.32,,,0,"percent of total billed charges","60% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",81.86,45,,65.49,,,0,"percent of total billed charges","45% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.24,65,,94.59,,,0,"percent of total billed charges","65% of total billed charges",80.22,27,,64.18,,,0,"percent of total billed charges","27% of total billed charges",172.81,95,,138.25,,,0,"percent of total billed charges","95% of total billed charges",181.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",160.08,88,,128.06,,,0,"percent of total billed charges","88% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",80.22,181.91,
"TYLENOL ELIXIR 5CC",2720000137,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TYLENOL ELIXIR 5CC",2720000138,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
TUMS,2720000141,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
TUMS,2720000142,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"TYLENOL W/CODEINE 5ML SYRUP",2720000145,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"TYLENOL W/CODEINE 5ML SYRUP",2720000146,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"COLCHICINE 0.6MG TAB",2720000149,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"COLCHICINE 0.6MG TAB",2720000150,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"VASOTEC 10MG TAB",2720000153,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"VASOTEC 10MG TAB",2720000154,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BACTROBAN 2% UNG 15G",2720000157,CDM,250,RC,,,Outpatient,,,317.52,158.76,,317.52,125,,,,,0,"fee schedule","125% of CMS fee schedule",241.32,76,,193.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",228.61,72,,182.89,,,0,"percent of total billed charges","72% of total billed charges",238.14,75,,190.51,,,0,"percent of total billed charges","75% of total billed charges",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",228.61,72,,182.89,,,0,"percent of total billed charges","72% of total billed charges",190.51,60,,152.41,,,0,"percent of total billed charges","60% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",142.88,45,,114.30,,,0,"percent of total billed charges","45% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",317.52,100,,,,,0,"fee schedule","100% CMS fee schedule",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",206.39,65,,165.11,,,0,"percent of total billed charges","65% of total billed charges",140.03,27,,112.02,,,0,"percent of total billed charges","27% of total billed charges",301.64,95,,241.31,,,0,"percent of total billed charges","95% of total billed charges",317.52,75,,,,,0,"fee schedule","75% of CMS fee schedule",279.42,88,,223.54,,,0,"percent of total billed charges","88% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",140.03,317.52,
"BACTROBAN 2% UNG 15G",2720000158,CDM,250,RC,,,Outpatient,,,317.52,158.76,,317.52,125,,,,,0,"fee schedule","125% of CMS fee schedule",241.32,76,,193.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",228.61,72,,182.89,,,0,"percent of total billed charges","72% of total billed charges",238.14,75,,190.51,,,0,"percent of total billed charges","75% of total billed charges",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",228.61,72,,182.89,,,0,"percent of total billed charges","72% of total billed charges",190.51,60,,152.41,,,0,"percent of total billed charges","60% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",142.88,45,,114.30,,,0,"percent of total billed charges","45% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",317.52,100,,,,,0,"fee schedule","100% CMS fee schedule",317.52,100,,,,,0,"fee schedule","100% of CMS fee schedule",206.39,65,,165.11,,,0,"percent of total billed charges","65% of total billed charges",140.03,27,,112.02,,,0,"percent of total billed charges","27% of total billed charges",301.64,95,,241.31,,,0,"percent of total billed charges","95% of total billed charges",317.52,75,,,,,0,"fee schedule","75% of CMS fee schedule",279.42,88,,223.54,,,0,"percent of total billed charges","88% of total billed charges",285.77,90,,228.62,,,0,"percent of total billed charges","90% of total billed charges",140.03,317.52,
"PROCARDIA XL 30MG TAB",2720000161,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"PROCARDIA XL 30MG TAB",2720000162,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"HYTRIN 1MG TAB",2720000165,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"HYTRIN 1MG TAB",2720000166,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"HYTRIN 5MG TAB",2720000169,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"HYTRIN 5MG TAB",2720000170,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"DIFLUCAN 100MG TAB",2720000173,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"DIFLUCAN 100MG TAB",2720000174,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"PEPTOBISMOL TAB",2720000177,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PEPTOBISMOL TAB",2720000178,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"AMBIEN 5MG TAB",2720000181,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"AMBIEN 5MG TAB",2720000182,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"IBUPROFEN 100MG/5ML SUSP",2720000185,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"IBUPROFEN 100MG/5ML SUSP",2720000186,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TETRACAINE 0.5% OPHTH SOLN",2720000189,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"TETRACAINE 0.5% OPHTH SOLN",2720000190,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"MAGOX 400 TAB",2720000193,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"MAGOX 400 TAB",2720000194,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"DURAGESIC25 PATCH",2720000197,CDM,250,RC,,,Outpatient,,,99.23,49.615,,99.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.41,76,,60.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",74.42,75,,59.54,,,0,"percent of total billed charges","75% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",59.54,60,,47.63,,,0,"percent of total billed charges","60% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",44.65,45,,35.72,,,0,"percent of total billed charges","45% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.5,65,,51.60,,,0,"percent of total billed charges","65% of total billed charges",43.76,27,,35.01,,,0,"percent of total billed charges","27% of total billed charges",94.27,95,,75.42,,,0,"percent of total billed charges","95% of total billed charges",99.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",87.32,88,,69.86,,,0,"percent of total billed charges","88% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",43.76,99.23,
"DURAGESIC25 PATCH",2720000198,CDM,250,RC,,,Outpatient,,,99.23,49.615,,99.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",75.41,76,,60.33,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",74.42,75,,59.54,,,0,"percent of total billed charges","75% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.45,72,,57.16,,,0,"percent of total billed charges","72% of total billed charges",59.54,60,,47.63,,,0,"percent of total billed charges","60% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",44.65,45,,35.72,,,0,"percent of total billed charges","45% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% CMS fee schedule",99.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.5,65,,51.60,,,0,"percent of total billed charges","65% of total billed charges",43.76,27,,35.01,,,0,"percent of total billed charges","27% of total billed charges",94.27,95,,75.42,,,0,"percent of total billed charges","95% of total billed charges",99.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",87.32,88,,69.86,,,0,"percent of total billed charges","88% of total billed charges",89.31,90,,71.45,,,0,"percent of total billed charges","90% of total billed charges",43.76,99.23,
"DURAGESIC 50MCG PATCH",2720000201,CDM,250,RC,,,Outpatient,,,288.86,144.43,,288.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",219.53,76,,175.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",207.98,72,,166.38,,,0,"percent of total billed charges","72% of total billed charges",216.65,75,,173.32,,,0,"percent of total billed charges","75% of total billed charges",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",207.98,72,,166.38,,,0,"percent of total billed charges","72% of total billed charges",173.32,60,,138.66,,,0,"percent of total billed charges","60% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",129.99,45,,103.99,,,0,"percent of total billed charges","45% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",288.86,100,,,,,0,"fee schedule","100% CMS fee schedule",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",187.76,65,,150.21,,,0,"percent of total billed charges","65% of total billed charges",127.39,27,,101.91,,,0,"percent of total billed charges","27% of total billed charges",274.42,95,,219.54,,,0,"percent of total billed charges","95% of total billed charges",288.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",254.2,88,,203.36,,,0,"percent of total billed charges","88% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",127.39,288.86,
"DURAGESIC 50MCG PATCH",2720000202,CDM,250,RC,,,Outpatient,,,288.86,144.43,,288.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",219.53,76,,175.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",207.98,72,,166.38,,,0,"percent of total billed charges","72% of total billed charges",216.65,75,,173.32,,,0,"percent of total billed charges","75% of total billed charges",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",207.98,72,,166.38,,,0,"percent of total billed charges","72% of total billed charges",173.32,60,,138.66,,,0,"percent of total billed charges","60% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",129.99,45,,103.99,,,0,"percent of total billed charges","45% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",288.86,100,,,,,0,"fee schedule","100% CMS fee schedule",288.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",187.76,65,,150.21,,,0,"percent of total billed charges","65% of total billed charges",127.39,27,,101.91,,,0,"percent of total billed charges","27% of total billed charges",274.42,95,,219.54,,,0,"percent of total billed charges","95% of total billed charges",288.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",254.2,88,,203.36,,,0,"percent of total billed charges","88% of total billed charges",259.97,90,,207.98,,,0,"percent of total billed charges","90% of total billed charges",127.39,288.86,
"JEVITY 8OZ",2720000205,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"JEVITY 8OZ",2720000206,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"BIAXIN 500MG TAB",2720000209,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"BIAXIN 500MG TAB",2720000210,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"MAXZIDE 25 TAB",2720000213,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"MAXZIDE 25 TAB",2720000214,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LORTAB 7.5 MG TAB",2720000217,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LORTAB 7.5 MG TAB",2720000218,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LOTENSIN 10MG TAB",2720000221,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LOTENSIN 10MG TAB",2720000222,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NIFEREX  150 CAP",2720000225,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"NIFEREX  150 CAP",2720000226,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DICLOXACILLIN 250MG CAP",2720000229,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DICLOXACILLIN 250MG CAP",2720000230,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ERYTHROMYCIN OPHTH OINT UD",2720000237,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"ERYTHROMYCIN OPHTH OINT UD",2720000238,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"NITROBID OINT 2PCT UD PKT",2720000241,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"NITROBID OINT 2PCT UD PKT",2720000242,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"PROPYLTHIOURACIL 50MG TAB",2720000245,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PROPYLTHIOURACIL 50MG TAB",2720000246,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NEUTRA PHOSK PACKET",2720000249,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"NEUTRA PHOSK PACKET",2720000250,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"METHIMAZOLE 10MG TAB",2720000253,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"METHIMAZOLE 10MG TAB",2720000254,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"HYDROCORTISONE 10MG TAB",2720000257,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"HYDROCORTISONE 10MG TAB",2720000258,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CELLUVISC 1PCT 0.3ML OPHTH",2720000261,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CELLUVISC 1PCT 0.3ML OPHTH",2720000262,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MISOPROSTOL 100MCG TAB",2720000265,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MISOPROSTOL 100MCG TAB",2720000266,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PAROXETINE 20MG TAB",2720000269,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PAROXETINE 20MG TAB",2720000270,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"BETADINE 10PCT SOLN",2720000273,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"BETADINE 10PCT SOLN",2720000274,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"VERAPAMIL 120MG SA TAB",2720000277,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"VERAPAMIL 120MG SA TAB",2720000278,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LEVOTHYROXINE 0.088MG TAB",2720000281,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"LEVOTHYROXINE 0.088MG TAB",2720000282,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"DOXAZOSIN 2MG TAB",2720000285,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"DOXAZOSIN 2MG TAB",2720000286,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"GLIPIZIDE 10MG TAB",2720000289,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLIPIZIDE 10MG TAB",2720000290,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TERCONAZOLE CRM 20GM",2720000293,CDM,250,RC,,,Outpatient,,,181.91,90.955,,181.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",138.25,76,,110.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",136.43,75,,109.14,,,0,"percent of total billed charges","75% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",109.15,60,,87.32,,,0,"percent of total billed charges","60% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",81.86,45,,65.49,,,0,"percent of total billed charges","45% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.24,65,,94.59,,,0,"percent of total billed charges","65% of total billed charges",80.22,27,,64.18,,,0,"percent of total billed charges","27% of total billed charges",172.81,95,,138.25,,,0,"percent of total billed charges","95% of total billed charges",181.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",160.08,88,,128.06,,,0,"percent of total billed charges","88% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",80.22,181.91,
"TERCONAZOLE CRM 20GM",2720000294,CDM,250,RC,,,Outpatient,,,181.91,90.955,,181.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",138.25,76,,110.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",136.43,75,,109.14,,,0,"percent of total billed charges","75% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.98,72,,104.78,,,0,"percent of total billed charges","72% of total billed charges",109.15,60,,87.32,,,0,"percent of total billed charges","60% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",81.86,45,,65.49,,,0,"percent of total billed charges","45% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% CMS fee schedule",181.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.24,65,,94.59,,,0,"percent of total billed charges","65% of total billed charges",80.22,27,,64.18,,,0,"percent of total billed charges","27% of total billed charges",172.81,95,,138.25,,,0,"percent of total billed charges","95% of total billed charges",181.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",160.08,88,,128.06,,,0,"percent of total billed charges","88% of total billed charges",163.72,90,,130.98,,,0,"percent of total billed charges","90% of total billed charges",80.22,181.91,
"CEPASTAT LOZ",2720000297,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CEPASTAT LOZ",2720000298,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HCTZ 25MG TAB",2720000301,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HCTZ 25MG TAB",2720000302,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"APAP/CAFF/BUTALB TAB",2720000305,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"APAP/CAFF/BUTALB TAB",2720000306,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LORATADINE 10MG TAB",2720000309,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"LORATADINE 10MG TAB",2720000310,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NITROGLY 2.5MG CAP",2720000313,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"NITROGLY 2.5MG CAP",2720000314,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"NICOTINE 21MG PATCH",2720000317,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"NICOTINE 21MG PATCH",2720000318,CDM,250,RC,,,Outpatient,,,82.69,41.345,,82.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.84,76,,50.27,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",62.02,75,,49.62,,,0,"percent of total billed charges","75% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.54,72,,47.63,,,0,"percent of total billed charges","72% of total billed charges",49.61,60,,39.69,,,0,"percent of total billed charges","60% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",37.21,45,,29.77,,,0,"percent of total billed charges","45% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% CMS fee schedule",82.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.75,65,,43.00,,,0,"percent of total billed charges","65% of total billed charges",36.47,27,,29.18,,,0,"percent of total billed charges","27% of total billed charges",78.56,95,,62.85,,,0,"percent of total billed charges","95% of total billed charges",82.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.77,88,,58.22,,,0,"percent of total billed charges","88% of total billed charges",74.42,90,,59.54,,,0,"percent of total billed charges","90% of total billed charges",36.47,82.69,
"NICOTINE 7MG PATCH",2720000321,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"NICOTINE 7MG PATCH",2720000322,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"FLUOCINONIDE 0.05PCT CREAM",2720000325,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"FLUOCINONIDE 0.05PCT CREAM",2720000326,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"BACITRACIN OPHTH OINT 3.5G",2720000329,CDM,250,RC,,,Outpatient,,,114.66,57.33,,114.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.14,76,,69.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",82.56,72,,66.05,,,0,"percent of total billed charges","72% of total billed charges",86,75,,68.80,,,0,"percent of total billed charges","75% of total billed charges",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.56,72,,66.05,,,0,"percent of total billed charges","72% of total billed charges",68.8,60,,55.04,,,0,"percent of total billed charges","60% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",51.6,45,,41.28,,,0,"percent of total billed charges","45% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.66,100,,,,,0,"fee schedule","100% CMS fee schedule",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.53,65,,59.62,,,0,"percent of total billed charges","65% of total billed charges",50.57,27,,40.46,,,0,"percent of total billed charges","27% of total billed charges",108.93,95,,87.14,,,0,"percent of total billed charges","95% of total billed charges",114.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",100.9,88,,80.72,,,0,"percent of total billed charges","88% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",50.57,114.66,
"BACITRACIN OPHTH OINT 3.5G",2720000330,CDM,250,RC,,,Outpatient,,,114.66,57.33,,114.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",87.14,76,,69.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",82.56,72,,66.05,,,0,"percent of total billed charges","72% of total billed charges",86,75,,68.80,,,0,"percent of total billed charges","75% of total billed charges",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.56,72,,66.05,,,0,"percent of total billed charges","72% of total billed charges",68.8,60,,55.04,,,0,"percent of total billed charges","60% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",51.6,45,,41.28,,,0,"percent of total billed charges","45% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",114.66,100,,,,,0,"fee schedule","100% CMS fee schedule",114.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.53,65,,59.62,,,0,"percent of total billed charges","65% of total billed charges",50.57,27,,40.46,,,0,"percent of total billed charges","27% of total billed charges",108.93,95,,87.14,,,0,"percent of total billed charges","95% of total billed charges",114.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",100.9,88,,80.72,,,0,"percent of total billed charges","88% of total billed charges",103.19,90,,82.55,,,0,"percent of total billed charges","90% of total billed charges",50.57,114.66,
"VIT A&D OINT 5GM",2720000333,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"VIT A&D OINT 5GM",2720000334,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PETROLATUM JELLY 30G",2720000337,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"PETROLATUM JELLY 30G",2720000338,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"RANITIDINE SYRUP 10ML",2720000341,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"RANITIDINE SYRUP 10ML",2720000342,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"LIDO VISC .2PCT 20ML",2720000345,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LIDO VISC .2PCT 20ML",2720000346,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"SALSALATE 500MG TAB",2720000349,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SALSALATE 500MG TAB",2720000350,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
NEPHROCAPS,2720000353,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
NEPHROCAPS,2720000354,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"RACEMICEPI 2.25% NEB",2720000357,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"RACEMICEPI 2.25% NEB",2720000358,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ASCORBIC ACID 500MG/5ML SYRUP",2720000361,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"ASCORBIC ACID 500MG/5ML SYRUP",2720000362,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PRENATAL TAB",2720000365,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PRENATAL TAB",2720000366,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ERGOCALCIFEROL 50,000 UNIT CAP",2720000369,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ERGOCALCIFEROL 50,000 UNIT CAP",2720000370,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HYOSCYAMINE 0.375MG TAB",2720000373,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"HYOSCYAMINE 0.375MG TAB",2720000374,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"CHLORHEXIDINE 15ML UD",2720000377,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CHLORHEXIDINE 15ML UD",2720000378,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"SOTALOL 80MG TAB",2720000381,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"SOTALOL 80MG TAB",2720000382,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"ISONIAZID 300MG TAB",2720000385,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ISONIAZID 300MG TAB",2720000386,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BENZTROPINE 1MG TAB",2720000389,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BENZTROPINE 1MG TAB",2720000390,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ATENOLOL 25MG TAB",2720000393,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ATENOLOL 25MG TAB",2720000394,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CALIUM ACETATE 667MG TAB",2720000397,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CALIUM ACETATE 667MG TAB",2720000398,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CHARCOAL/SORB 25GM/120ML",2720000401,CDM,250,RC,,,Outpatient,,,63.95,31.975,,63.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",48.6,76,,38.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",47.96,75,,38.37,,,0,"percent of total billed charges","75% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",38.37,60,,30.70,,,0,"percent of total billed charges","60% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.78,45,,23.02,,,0,"percent of total billed charges","45% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.57,65,,33.26,,,0,"percent of total billed charges","65% of total billed charges",28.2,27,,22.56,,,0,"percent of total billed charges","27% of total billed charges",60.75,95,,48.60,,,0,"percent of total billed charges","95% of total billed charges",63.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",56.28,88,,45.02,,,0,"percent of total billed charges","88% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.2,63.95,
"CHARCOAL/SORB 25GM/120ML",2720000402,CDM,250,RC,,,Outpatient,,,63.95,31.975,,63.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",48.6,76,,38.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",47.96,75,,38.37,,,0,"percent of total billed charges","75% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.04,72,,36.83,,,0,"percent of total billed charges","72% of total billed charges",38.37,60,,30.70,,,0,"percent of total billed charges","60% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.78,45,,23.02,,,0,"percent of total billed charges","45% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% CMS fee schedule",63.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.57,65,,33.26,,,0,"percent of total billed charges","65% of total billed charges",28.2,27,,22.56,,,0,"percent of total billed charges","27% of total billed charges",60.75,95,,48.60,,,0,"percent of total billed charges","95% of total billed charges",63.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",56.28,88,,45.02,,,0,"percent of total billed charges","88% of total billed charges",57.56,90,,46.05,,,0,"percent of total billed charges","90% of total billed charges",28.2,63.95,
"HYDROCORTISONE 1% 30G",2720000405,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"HYDROCORTISONE 1% 30G",2720000406,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"PHENERGAN 25MG SUP #4E",2720000409,CDM,250,RC,,,Outpatient,,,68.36,34.18,,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",49.22,72,,39.38,,,0,"percent of total billed charges","72% of total billed charges",51.27,75,,41.02,,,0,"percent of total billed charges","75% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.22,72,,39.38,,,0,"percent of total billed charges","72% of total billed charges",41.02,60,,32.82,,,0,"percent of total billed charges","60% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,24.12,,,0,"percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,48.13,,,0,"percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",30.15,68.36,
"PHENERGAN 25MG SUP #4E",2720000410,CDM,250,RC,,,Outpatient,,,68.36,34.18,,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",49.22,72,,39.38,,,0,"percent of total billed charges","72% of total billed charges",51.27,75,,41.02,,,0,"percent of total billed charges","75% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.22,72,,39.38,,,0,"percent of total billed charges","72% of total billed charges",41.02,60,,32.82,,,0,"percent of total billed charges","60% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,24.12,,,0,"percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,48.13,,,0,"percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",30.15,68.36,
"METOCLOPRAMIDE 10MG/10ML SOLN",2720000413,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"METOCLOPRAMIDE 10MG/10ML SOLN",2720000414,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LIDOCAINE 4# TOP SOLN",2720000417,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"LIDOCAINE 4# TOP SOLN",2720000418,CDM,250,RC,,,Outpatient,,,72.77,36.385,,72.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",55.31,76,,44.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",54.58,75,,43.66,,,0,"percent of total billed charges","75% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.39,72,,41.91,,,0,"percent of total billed charges","72% of total billed charges",43.66,60,,34.93,,,0,"percent of total billed charges","60% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.75,45,,26.20,,,0,"percent of total billed charges","45% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% CMS fee schedule",72.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.3,65,,37.84,,,0,"percent of total billed charges","65% of total billed charges",32.09,27,,25.67,,,0,"percent of total billed charges","27% of total billed charges",69.13,95,,55.30,,,0,"percent of total billed charges","95% of total billed charges",72.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",64.04,88,,51.23,,,0,"percent of total billed charges","88% of total billed charges",65.49,90,,52.39,,,0,"percent of total billed charges","90% of total billed charges",32.09,72.77,
"RAMIPRIL 2.5MG CAP",2720000421,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"RAMIPRIL 2.5MG CAP",2720000422,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ACETAMINOPHEN 325MG SUPP",2720000425,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ACETAMINOPHEN 325MG SUPP",2720000426,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"URSODIOL 300MG CAP",2720000429,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"URSODIOL 300MG CAP",2720000430,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"DURAGESIC 75MCG/HR PATCH",2720000433,CDM,250,RC,,,Outpatient,,,468.56,234.28,,468.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",356.11,76,,284.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",351.42,75,,281.14,,,0,"percent of total billed charges","75% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",281.14,60,,224.91,,,0,"percent of total billed charges","60% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",210.85,45,,168.68,,,0,"percent of total billed charges","45% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",304.56,65,,243.65,,,0,"percent of total billed charges","65% of total billed charges",206.63,27,,165.30,,,0,"percent of total billed charges","27% of total billed charges",445.13,95,,356.10,,,0,"percent of total billed charges","95% of total billed charges",468.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",412.33,88,,329.86,,,0,"percent of total billed charges","88% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",206.63,468.56,
"DURAGESIC 75MCG/HR PATCH",2720000434,CDM,250,RC,,,Outpatient,,,468.56,234.28,,468.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",356.11,76,,284.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",351.42,75,,281.14,,,0,"percent of total billed charges","75% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",281.14,60,,224.91,,,0,"percent of total billed charges","60% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",210.85,45,,168.68,,,0,"percent of total billed charges","45% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",304.56,65,,243.65,,,0,"percent of total billed charges","65% of total billed charges",206.63,27,,165.30,,,0,"percent of total billed charges","27% of total billed charges",445.13,95,,356.10,,,0,"percent of total billed charges","95% of total billed charges",468.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",412.33,88,,329.86,,,0,"percent of total billed charges","88% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",206.63,468.56,
"BICITRA SOL 30ML",2720000437,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"BICITRA SOL 30ML",2720000438,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LEVOTHROID 0.075MG TAB",2720000441,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"LEVOTHROID 0.075MG TAB",2720000442,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BENADRYL 12.5MG/5ML SYRUP",2720000445,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"BENADRYL 12.5MG/5ML SYRUP",2720000446,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROCHLORPERAZINE 10MG/2ML",2720000449,CDM,250,RC,J0780,HCPCS,Outpatient,,,10.2,5.1,,10.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.75,76,,6.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.77,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",44.77,350,,,,,0,"fee schedule","350% of BCBS fee schedule",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.77,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",12.79,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",4.59,45,,3.67,,,0,"percent of total billed charges","45% of total billed charges",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.2,100,,,,,0,"fee schedule","100% CMS fee schedule",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,65,,5.30,,,0,"percent of total billed charges","65% of total billed charges",4.5,27,,3.60,,,0,"percent of total billed charges","27% of total billed charges",9.69,95,,7.75,,,0,"percent of total billed charges","95% of total billed charges",10.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.98,88,,7.18,,,0,"percent of total billed charges","88% of total billed charges",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",4.5,44.77,
"PROCHLORPERAZINE 10MG/2ML",2720000450,CDM,250,RC,,,Outpatient,,,10.2,5.1,,10.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.75,76,,6.20,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.34,72,,5.87,,,0,"percent of total billed charges","72% of total billed charges",7.65,75,,6.12,,,0,"percent of total billed charges","75% of total billed charges",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.34,72,,5.87,,,0,"percent of total billed charges","72% of total billed charges",6.12,60,,4.90,,,0,"percent of total billed charges","60% of total billed charges",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",4.59,45,,3.67,,,0,"percent of total billed charges","45% of total billed charges",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.2,100,,,,,0,"fee schedule","100% CMS fee schedule",10.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.63,65,,5.30,,,0,"percent of total billed charges","65% of total billed charges",4.5,27,,3.60,,,0,"percent of total billed charges","27% of total billed charges",9.69,95,,7.75,,,0,"percent of total billed charges","95% of total billed charges",10.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.98,88,,7.18,,,0,"percent of total billed charges","88% of total billed charges",9.18,90,,7.34,,,0,"percent of total billed charges","90% of total billed charges",4.5,10.2,
"KEFLEX HM 250MG 4S",2720000453,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"KEFLEX HM 250MG 4S",2720000454,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"PROZAC 10MG CAP",2720000457,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"PROZAC 10MG CAP",2720000458,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"LOMOTIL HM 4E",2720000461,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LOMOTIL HM 4E",2720000462,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"EMLA 5GM",2720000465,CDM,250,RC,,,Outpatient,,,171.99,85.995,,171.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",130.71,76,,104.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",123.83,72,,99.06,,,0,"percent of total billed charges","72% of total billed charges",128.99,75,,103.19,,,0,"percent of total billed charges","75% of total billed charges",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.83,72,,99.06,,,0,"percent of total billed charges","72% of total billed charges",103.19,60,,82.55,,,0,"percent of total billed charges","60% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",77.4,45,,61.92,,,0,"percent of total billed charges","45% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,100,,,,,0,"fee schedule","100% CMS fee schedule",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",111.79,65,,89.43,,,0,"percent of total billed charges","65% of total billed charges",75.85,27,,60.68,,,0,"percent of total billed charges","27% of total billed charges",163.39,95,,130.71,,,0,"percent of total billed charges","95% of total billed charges",171.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",151.35,88,,121.08,,,0,"percent of total billed charges","88% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",75.85,171.99,
"EMLA 5GM",2720000466,CDM,250,RC,,,Outpatient,,,171.99,85.995,,171.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",130.71,76,,104.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",123.83,72,,99.06,,,0,"percent of total billed charges","72% of total billed charges",128.99,75,,103.19,,,0,"percent of total billed charges","75% of total billed charges",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",123.83,72,,99.06,,,0,"percent of total billed charges","72% of total billed charges",103.19,60,,82.55,,,0,"percent of total billed charges","60% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",77.4,45,,61.92,,,0,"percent of total billed charges","45% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.99,100,,,,,0,"fee schedule","100% CMS fee schedule",171.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",111.79,65,,89.43,,,0,"percent of total billed charges","65% of total billed charges",75.85,27,,60.68,,,0,"percent of total billed charges","27% of total billed charges",163.39,95,,130.71,,,0,"percent of total billed charges","95% of total billed charges",171.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",151.35,88,,121.08,,,0,"percent of total billed charges","88% of total billed charges",154.79,90,,123.83,,,0,"percent of total billed charges","90% of total billed charges",75.85,171.99,
"DETROL 2MG TAB",2720000469,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"DETROL 2MG TAB",2720000470,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"EVISTA 60MG TAB",2720000473,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"EVISTA 60MG TAB",2720000474,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"REMERON 15MG TAB",2720000477,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"REMERON 15MG TAB",2720000478,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"ASACOL 400MG TAB",2720000481,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ASACOL 400MG TAB",2720000482,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"B.S.S. 30ML",2720000485,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"B.S.S. 30ML",2720000486,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"GLUROPHAGE 850MG TAB",2720000489,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"GLUROPHAGE 850MG TAB",2720000490,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"HEMOCYTE PLUS TAB",2720000493,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"HEMOCYTE PLUS TAB",2720000494,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NICODERM 14MG PATCH",2720000497,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"NICODERM 14MG PATCH",2720000498,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"NITRODUR 0.3MG PATCH",2720000501,CDM,250,RC,,,Outpatient,,,205.07,102.535,,205.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",155.85,76,,124.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",147.65,72,,118.12,,,0,"percent of total billed charges","72% of total billed charges",153.8,75,,123.04,,,0,"percent of total billed charges","75% of total billed charges",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",147.65,72,,118.12,,,0,"percent of total billed charges","72% of total billed charges",123.04,60,,98.43,,,0,"percent of total billed charges","60% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",92.28,45,,73.82,,,0,"percent of total billed charges","45% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.07,100,,,,,0,"fee schedule","100% CMS fee schedule",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",133.3,65,,106.64,,,0,"percent of total billed charges","65% of total billed charges",90.44,27,,72.35,,,0,"percent of total billed charges","27% of total billed charges",194.82,95,,155.86,,,0,"percent of total billed charges","95% of total billed charges",205.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",180.46,88,,144.37,,,0,"percent of total billed charges","88% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",90.44,205.07,
"NITRODUR 0.3MG PATCH",2720000502,CDM,250,RC,,,Outpatient,,,205.07,102.535,,205.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",155.85,76,,124.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",147.65,72,,118.12,,,0,"percent of total billed charges","72% of total billed charges",153.8,75,,123.04,,,0,"percent of total billed charges","75% of total billed charges",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",147.65,72,,118.12,,,0,"percent of total billed charges","72% of total billed charges",123.04,60,,98.43,,,0,"percent of total billed charges","60% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",92.28,45,,73.82,,,0,"percent of total billed charges","45% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.07,100,,,,,0,"fee schedule","100% CMS fee schedule",205.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",133.3,65,,106.64,,,0,"percent of total billed charges","65% of total billed charges",90.44,27,,72.35,,,0,"percent of total billed charges","27% of total billed charges",194.82,95,,155.86,,,0,"percent of total billed charges","95% of total billed charges",205.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",180.46,88,,144.37,,,0,"percent of total billed charges","88% of total billed charges",184.56,90,,147.65,,,0,"percent of total billed charges","90% of total billed charges",90.44,205.07,
"ZYPREXA 5MG TAB",2720000505,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"ZYPREXA 5MG TAB",2720000506,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"AZOPT 1%0PHTH SOL",2720000509,CDM,250,RC,,,Outpatient,,,262.4,131.2,,262.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",199.42,76,,159.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",196.8,75,,157.44,,,0,"percent of total billed charges","75% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",157.44,60,,125.95,,,0,"percent of total billed charges","60% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",118.08,45,,94.46,,,0,"percent of total billed charges","45% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",170.56,65,,136.45,,,0,"percent of total billed charges","65% of total billed charges",115.72,27,,92.58,,,0,"percent of total billed charges","27% of total billed charges",249.28,95,,199.42,,,0,"percent of total billed charges","95% of total billed charges",262.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",230.91,88,,184.73,,,0,"percent of total billed charges","88% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",115.72,262.4,
"AZOPT 1%0PHTH SOL",2720000510,CDM,250,RC,,,Outpatient,,,262.4,131.2,,262.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",199.42,76,,159.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",196.8,75,,157.44,,,0,"percent of total billed charges","75% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.93,72,,151.14,,,0,"percent of total billed charges","72% of total billed charges",157.44,60,,125.95,,,0,"percent of total billed charges","60% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",118.08,45,,94.46,,,0,"percent of total billed charges","45% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% CMS fee schedule",262.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",170.56,65,,136.45,,,0,"percent of total billed charges","65% of total billed charges",115.72,27,,92.58,,,0,"percent of total billed charges","27% of total billed charges",249.28,95,,199.42,,,0,"percent of total billed charges","95% of total billed charges",262.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",230.91,88,,184.73,,,0,"percent of total billed charges","88% of total billed charges",236.16,90,,188.93,,,0,"percent of total billed charges","90% of total billed charges",115.72,262.4,
"CRIXIVAN 200MG CAP",2720000513,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CRIXIVAN 200MG CAP",2720000514,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"HEMOCYTE 324MG TAB",2720000517,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"HEMOCYTE 324MG TAB",2720000518,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"SINGULAR 10MG TAB",2720000521,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"SINGULAR 10MG TAB",2720000522,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"THERAGESIC CREME",2720000525,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"THERAGESIC CREME",2720000526,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"VITAMIN E 1000 UNIT CAP",2720000529,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN E 1000 UNIT CAP",2720000530,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"COSPT OPHT SOL",2720000533,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"COSPT OPHT SOL",2720000534,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"VERSED 2MG/ML SYRUP 5ML",2720000537,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"VERSED 2MG/ML SYRUP 5ML",2720000538,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"AVAPRO 150MG TAB",2720000541,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"AVAPRO 150MG TAB",2720000542,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"VITAMIN B12 TAB 1000MCG",2720000545,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VITAMIN B12 TAB 1000MCG",2720000546,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"EPIVIR 150MG TAB",2720000549,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"EPIVIR 150MG TAB",2720000550,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"ERY TAB 500MG",2720000553,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ERY TAB 500MG",2720000554,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"FLOMAX 0.4MG CAP",2720000557,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"FLOMAX 0.4MG CAP",2720000558,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"LAMISIL 250MG TAB",2720000561,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"LAMISIL 250MG TAB",2720000562,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"MYCOLOG OINT 15G",2720000565,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"MYCOLOG OINT 15G",2720000566,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"POLYTRIM OPHTH SOLN 10ML",2720000569,CDM,250,RC,,,Outpatient,,,70.56,35.28,,70.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",53.63,76,,42.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",50.8,72,,40.64,,,0,"percent of total billed charges","72% of total billed charges",52.92,75,,42.34,,,0,"percent of total billed charges","75% of total billed charges",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.8,72,,40.64,,,0,"percent of total billed charges","72% of total billed charges",42.34,60,,33.87,,,0,"percent of total billed charges","60% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",31.75,45,,25.40,,,0,"percent of total billed charges","45% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.56,100,,,,,0,"fee schedule","100% CMS fee schedule",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.86,65,,36.69,,,0,"percent of total billed charges","65% of total billed charges",31.12,27,,24.90,,,0,"percent of total billed charges","27% of total billed charges",67.03,95,,53.62,,,0,"percent of total billed charges","95% of total billed charges",70.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",62.09,88,,49.67,,,0,"percent of total billed charges","88% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",31.12,70.56,
"POLYTRIM OPHTH SOLN 10ML",2720000570,CDM,250,RC,,,Outpatient,,,70.56,35.28,,70.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",53.63,76,,42.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",50.8,72,,40.64,,,0,"percent of total billed charges","72% of total billed charges",52.92,75,,42.34,,,0,"percent of total billed charges","75% of total billed charges",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.8,72,,40.64,,,0,"percent of total billed charges","72% of total billed charges",42.34,60,,33.87,,,0,"percent of total billed charges","60% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",31.75,45,,25.40,,,0,"percent of total billed charges","45% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.56,100,,,,,0,"fee schedule","100% CMS fee schedule",70.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.86,65,,36.69,,,0,"percent of total billed charges","65% of total billed charges",31.12,27,,24.90,,,0,"percent of total billed charges","27% of total billed charges",67.03,95,,53.62,,,0,"percent of total billed charges","95% of total billed charges",70.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",62.09,88,,49.67,,,0,"percent of total billed charges","88% of total billed charges",63.5,90,,50.80,,,0,"percent of total billed charges","90% of total billed charges",31.12,70.56,
"SEROQUEL 100MG TAB",2720000573,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"SEROQUEL 100MG TAB",2720000574,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"STRESS 600 TAB",2720000577,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"STRESS 600 TAB",2720000578,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"WELLBUTRIN SR 150MG",2720000581,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"WELLBUTRIN SR 150MG",2720000582,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"DIPROLENE .05 CREAM",2720000585,CDM,250,RC,,,Outpatient,,,303.19,151.595,,303.19,125,,,,,0,"fee schedule","125% of CMS fee schedule",230.42,76,,184.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",218.3,72,,174.64,,,0,"percent of total billed charges","72% of total billed charges",227.39,75,,181.91,,,0,"percent of total billed charges","75% of total billed charges",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",218.3,72,,174.64,,,0,"percent of total billed charges","72% of total billed charges",181.91,60,,145.53,,,0,"percent of total billed charges","60% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",136.44,45,,109.15,,,0,"percent of total billed charges","45% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",303.19,100,,,,,0,"fee schedule","100% CMS fee schedule",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",197.07,65,,157.66,,,0,"percent of total billed charges","65% of total billed charges",133.71,27,,106.97,,,0,"percent of total billed charges","27% of total billed charges",288.03,95,,230.42,,,0,"percent of total billed charges","95% of total billed charges",303.19,75,,,,,0,"fee schedule","75% of CMS fee schedule",266.81,88,,213.45,,,0,"percent of total billed charges","88% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",133.71,303.19,
"DIPROLENE .05 CREAM",2720000586,CDM,250,RC,,,Outpatient,,,303.19,151.595,,303.19,125,,,,,0,"fee schedule","125% of CMS fee schedule",230.42,76,,184.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",218.3,72,,174.64,,,0,"percent of total billed charges","72% of total billed charges",227.39,75,,181.91,,,0,"percent of total billed charges","75% of total billed charges",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",218.3,72,,174.64,,,0,"percent of total billed charges","72% of total billed charges",181.91,60,,145.53,,,0,"percent of total billed charges","60% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",136.44,45,,109.15,,,0,"percent of total billed charges","45% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",303.19,100,,,,,0,"fee schedule","100% CMS fee schedule",303.19,100,,,,,0,"fee schedule","100% of CMS fee schedule",197.07,65,,157.66,,,0,"percent of total billed charges","65% of total billed charges",133.71,27,,106.97,,,0,"percent of total billed charges","27% of total billed charges",288.03,95,,230.42,,,0,"percent of total billed charges","95% of total billed charges",303.19,75,,,,,0,"fee schedule","75% of CMS fee schedule",266.81,88,,213.45,,,0,"percent of total billed charges","88% of total billed charges",272.87,90,,218.30,,,0,"percent of total billed charges","90% of total billed charges",133.71,303.19,
"LIPITOR 40MG TAB",2720000589,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"LIPITOR 40MG TAB",2720000590,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"SALIVA SUBSTITUTE",2720000593,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"SALIVA SUBSTITUTE",2720000594,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"TOPAMAX 25MG TAB",2720000597,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"TOPAMAX 25MG TAB",2720000598,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"WELLBUTRIN SR 100MG",2720000601,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"WELLBUTRIN SR 100MG",2720000602,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"WELLBUTRIN 100MG TAB",2720000605,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"WELLBUTRIN 100MG TAB",2720000606,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"BLEPHAMIDE .2 OPHT",2720000609,CDM,250,RC,,,Outpatient,,,325.24,162.62,,325.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",247.18,76,,197.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",243.93,75,,195.14,,,0,"percent of total billed charges","75% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",195.14,60,,156.11,,,0,"percent of total billed charges","60% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",146.36,45,,117.09,,,0,"percent of total billed charges","45% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.41,65,,169.13,,,0,"percent of total billed charges","65% of total billed charges",143.43,27,,114.74,,,0,"percent of total billed charges","27% of total billed charges",308.98,95,,247.18,,,0,"percent of total billed charges","95% of total billed charges",325.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",286.21,88,,228.97,,,0,"percent of total billed charges","88% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",143.43,325.24,
"BLEPHAMIDE .2 OPHT",2720000610,CDM,250,RC,,,Outpatient,,,325.24,162.62,,325.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",247.18,76,,197.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",243.93,75,,195.14,,,0,"percent of total billed charges","75% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",195.14,60,,156.11,,,0,"percent of total billed charges","60% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",146.36,45,,117.09,,,0,"percent of total billed charges","45% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.41,65,,169.13,,,0,"percent of total billed charges","65% of total billed charges",143.43,27,,114.74,,,0,"percent of total billed charges","27% of total billed charges",308.98,95,,247.18,,,0,"percent of total billed charges","95% of total billed charges",325.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",286.21,88,,228.97,,,0,"percent of total billed charges","88% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",143.43,325.24,
"DEMADEX 20MG TAB",2720000613,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"DEMADEX 20MG TAB",2720000614,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"EFFEXOR XR 37.5MG TA",2720000617,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"EFFEXOR XR 37.5MG TA",2720000618,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"TOBRADEX OINT",2720000621,CDM,250,RC,,,Outpatient,,,396.9,198.45,,396.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",301.64,76,,241.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",285.77,72,,228.62,,,0,"percent of total billed charges","72% of total billed charges",297.68,75,,238.14,,,0,"percent of total billed charges","75% of total billed charges",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.77,72,,228.62,,,0,"percent of total billed charges","72% of total billed charges",238.14,60,,190.51,,,0,"percent of total billed charges","60% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",178.61,45,,142.89,,,0,"percent of total billed charges","45% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",396.9,100,,,,,0,"fee schedule","100% CMS fee schedule",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.99,65,,206.39,,,0,"percent of total billed charges","65% of total billed charges",175.03,27,,140.02,,,0,"percent of total billed charges","27% of total billed charges",377.06,95,,301.65,,,0,"percent of total billed charges","95% of total billed charges",396.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",349.27,88,,279.42,,,0,"percent of total billed charges","88% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",175.03,396.9,
"TOBRADEX OINT",2720000622,CDM,250,RC,,,Outpatient,,,396.9,198.45,,396.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",301.64,76,,241.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",285.77,72,,228.62,,,0,"percent of total billed charges","72% of total billed charges",297.68,75,,238.14,,,0,"percent of total billed charges","75% of total billed charges",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.77,72,,228.62,,,0,"percent of total billed charges","72% of total billed charges",238.14,60,,190.51,,,0,"percent of total billed charges","60% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",178.61,45,,142.89,,,0,"percent of total billed charges","45% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",396.9,100,,,,,0,"fee schedule","100% CMS fee schedule",396.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",257.99,65,,206.39,,,0,"percent of total billed charges","65% of total billed charges",175.03,27,,140.02,,,0,"percent of total billed charges","27% of total billed charges",377.06,95,,301.65,,,0,"percent of total billed charges","95% of total billed charges",396.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",349.27,88,,279.42,,,0,"percent of total billed charges","88% of total billed charges",357.21,90,,285.77,,,0,"percent of total billed charges","90% of total billed charges",175.03,396.9,
"METROGEL VAGINAL",2720000625,CDM,250,RC,,,Outpatient,,,345.08,172.54,,345.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",262.26,76,,209.81,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",248.46,72,,198.77,,,0,"percent of total billed charges","72% of total billed charges",258.81,75,,207.05,,,0,"percent of total billed charges","75% of total billed charges",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",248.46,72,,198.77,,,0,"percent of total billed charges","72% of total billed charges",207.05,60,,165.64,,,0,"percent of total billed charges","60% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",155.29,45,,124.23,,,0,"percent of total billed charges","45% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",345.08,100,,,,,0,"fee schedule","100% CMS fee schedule",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.3,65,,179.44,,,0,"percent of total billed charges","65% of total billed charges",152.18,27,,121.74,,,0,"percent of total billed charges","27% of total billed charges",327.83,95,,262.26,,,0,"percent of total billed charges","95% of total billed charges",345.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",303.67,88,,242.94,,,0,"percent of total billed charges","88% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",152.18,345.08,
"METROGEL VAGINAL",2720000626,CDM,250,RC,,,Outpatient,,,345.08,172.54,,345.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",262.26,76,,209.81,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",248.46,72,,198.77,,,0,"percent of total billed charges","72% of total billed charges",258.81,75,,207.05,,,0,"percent of total billed charges","75% of total billed charges",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",248.46,72,,198.77,,,0,"percent of total billed charges","72% of total billed charges",207.05,60,,165.64,,,0,"percent of total billed charges","60% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",155.29,45,,124.23,,,0,"percent of total billed charges","45% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",345.08,100,,,,,0,"fee schedule","100% CMS fee schedule",345.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.3,65,,179.44,,,0,"percent of total billed charges","65% of total billed charges",152.18,27,,121.74,,,0,"percent of total billed charges","27% of total billed charges",327.83,95,,262.26,,,0,"percent of total billed charges","95% of total billed charges",345.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",303.67,88,,242.94,,,0,"percent of total billed charges","88% of total billed charges",310.57,90,,248.46,,,0,"percent of total billed charges","90% of total billed charges",152.18,345.08,
"VICODIN TABS4(E)",2720000629,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"VICODIN TABS4(E)",2720000630,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MIDODRINE 5MG TAB",2720000634,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MIDODRINE 5MG TAB",2720000635,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TETRACAINE 0.5% SOLN",2720000638,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"TETRACAINE 0.5% SOLN",2720000639,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"ACTOS 30MG TAB",2720000642,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"ACTOS 30MG TAB",2720000643,CDM,250,RC,,,Outpatient,,,41.9,20.95,,41.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",31.84,76,,25.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",31.43,75,,25.14,,,0,"percent of total billed charges","75% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.17,72,,24.14,,,0,"percent of total billed charges","72% of total billed charges",25.14,60,,20.11,,,0,"percent of total billed charges","60% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.86,45,,15.09,,,0,"percent of total billed charges","45% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% CMS fee schedule",41.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.24,65,,21.79,,,0,"percent of total billed charges","65% of total billed charges",18.48,27,,14.78,,,0,"percent of total billed charges","27% of total billed charges",39.81,95,,31.85,,,0,"percent of total billed charges","95% of total billed charges",41.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",36.87,88,,29.50,,,0,"percent of total billed charges","88% of total billed charges",37.71,90,,30.17,,,0,"percent of total billed charges","90% of total billed charges",18.48,41.9,
"CELEXA 20MG TAB",2720000646,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"CELEXA 20MG TAB",2720000647,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"PATANOL .1% OPHTH SOLN",2720000650,CDM,250,RC,,,Outpatient,,,569.99,284.995,,569.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",433.19,76,,346.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",410.39,72,,328.31,,,0,"percent of total billed charges","72% of total billed charges",427.49,75,,341.99,,,0,"percent of total billed charges","75% of total billed charges",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",410.39,72,,328.31,,,0,"percent of total billed charges","72% of total billed charges",341.99,60,,273.59,,,0,"percent of total billed charges","60% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",256.5,45,,205.20,,,0,"percent of total billed charges","45% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",569.99,100,,,,,0,"fee schedule","100% CMS fee schedule",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",370.49,65,,296.39,,,0,"percent of total billed charges","65% of total billed charges",251.37,27,,201.10,,,0,"percent of total billed charges","27% of total billed charges",541.49,95,,433.19,,,0,"percent of total billed charges","95% of total billed charges",569.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",501.59,88,,401.27,,,0,"percent of total billed charges","88% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",251.37,569.99,
"PATANOL .1% OPHTH SOLN",2720000651,CDM,250,RC,,,Outpatient,,,569.99,284.995,,569.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",433.19,76,,346.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",410.39,72,,328.31,,,0,"percent of total billed charges","72% of total billed charges",427.49,75,,341.99,,,0,"percent of total billed charges","75% of total billed charges",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",410.39,72,,328.31,,,0,"percent of total billed charges","72% of total billed charges",341.99,60,,273.59,,,0,"percent of total billed charges","60% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",256.5,45,,205.20,,,0,"percent of total billed charges","45% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",569.99,100,,,,,0,"fee schedule","100% CMS fee schedule",569.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",370.49,65,,296.39,,,0,"percent of total billed charges","65% of total billed charges",251.37,27,,201.10,,,0,"percent of total billed charges","27% of total billed charges",541.49,95,,433.19,,,0,"percent of total billed charges","95% of total billed charges",569.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",501.59,88,,401.27,,,0,"percent of total billed charges","88% of total billed charges",512.99,90,,410.39,,,0,"percent of total billed charges","90% of total billed charges",251.37,569.99,
"PSORCON .05 CREAM",2720000654,CDM,250,RC,,,Outpatient,,,285.55,142.775,,285.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",217.02,76,,173.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",214.16,75,,171.33,,,0,"percent of total billed charges","75% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",171.33,60,,137.06,,,0,"percent of total billed charges","60% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",128.5,45,,102.80,,,0,"percent of total billed charges","45% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",185.61,65,,148.49,,,0,"percent of total billed charges","65% of total billed charges",125.93,27,,100.74,,,0,"percent of total billed charges","27% of total billed charges",271.27,95,,217.02,,,0,"percent of total billed charges","95% of total billed charges",285.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",251.28,88,,201.02,,,0,"percent of total billed charges","88% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",125.93,285.55,
"PSORCON .05 CREAM",2720000655,CDM,250,RC,,,Outpatient,,,285.55,142.775,,285.55,125,,,,,0,"fee schedule","125% of CMS fee schedule",217.02,76,,173.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",214.16,75,,171.33,,,0,"percent of total billed charges","75% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",205.6,72,,164.48,,,0,"percent of total billed charges","72% of total billed charges",171.33,60,,137.06,,,0,"percent of total billed charges","60% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",128.5,45,,102.80,,,0,"percent of total billed charges","45% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% CMS fee schedule",285.55,100,,,,,0,"fee schedule","100% of CMS fee schedule",185.61,65,,148.49,,,0,"percent of total billed charges","65% of total billed charges",125.93,27,,100.74,,,0,"percent of total billed charges","27% of total billed charges",271.27,95,,217.02,,,0,"percent of total billed charges","95% of total billed charges",285.55,75,,,,,0,"fee schedule","75% of CMS fee schedule",251.28,88,,201.02,,,0,"percent of total billed charges","88% of total billed charges",257,90,,205.60,,,0,"percent of total billed charges","90% of total billed charges",125.93,285.55,
"ATACAND 16MG TAB",2720000658,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"ATACAND 16MG TAB",2720000659,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LEVAQUIN 250MG TAB",2720000662,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"LEVAQUIN 250MG TAB",2720000663,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"TRIAMCINOLONE 0.025% CREAM",2720000666,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"TRIAMCINOLONE 0.025% CREAM",2720000667,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"ARAVA 10MG TAB",2720000670,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"ARAVA 10MG TAB",2720000671,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"AGGRENOX 25/200 CAP",2720000674,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"AGGRENOX 25/200 CAP",2720000675,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"ENSURE LIGHT SUPPL",2720000678,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ENSURE LIGHT SUPPL",2720000679,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"CASODEX 50MG TAB",2720000682,CDM,250,RC,,,Outpatient,,,80.48,40.24,,80.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",61.16,76,,48.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",60.36,75,,48.29,,,0,"percent of total billed charges","75% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",48.29,60,,38.63,,,0,"percent of total billed charges","60% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",36.22,45,,28.98,,,0,"percent of total billed charges","45% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.31,65,,41.85,,,0,"percent of total billed charges","65% of total billed charges",35.49,27,,28.39,,,0,"percent of total billed charges","27% of total billed charges",76.46,95,,61.17,,,0,"percent of total billed charges","95% of total billed charges",80.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",70.82,88,,56.66,,,0,"percent of total billed charges","88% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",35.49,80.48,
"CASODEX 50MG TAB",2720000683,CDM,250,RC,,,Outpatient,,,80.48,40.24,,80.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",61.16,76,,48.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",60.36,75,,48.29,,,0,"percent of total billed charges","75% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",48.29,60,,38.63,,,0,"percent of total billed charges","60% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",36.22,45,,28.98,,,0,"percent of total billed charges","45% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.31,65,,41.85,,,0,"percent of total billed charges","65% of total billed charges",35.49,27,,28.39,,,0,"percent of total billed charges","27% of total billed charges",76.46,95,,61.17,,,0,"percent of total billed charges","95% of total billed charges",80.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",70.82,88,,56.66,,,0,"percent of total billed charges","88% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",35.49,80.48,
"PRINIVIL 2.5MG TAB",2720000686,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PRINIVIL 2.5MG TAB",2720000687,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TRANS DERM SCOP 1.5MG PATCH",2720000691,CDM,250,RC,,,Outpatient,,,73.87,36.935,,73.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.14,76,,44.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.19,72,,42.55,,,0,"percent of total billed charges","72% of total billed charges",55.4,75,,44.32,,,0,"percent of total billed charges","75% of total billed charges",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.19,72,,42.55,,,0,"percent of total billed charges","72% of total billed charges",44.32,60,,35.46,,,0,"percent of total billed charges","60% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",33.24,45,,26.59,,,0,"percent of total billed charges","45% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",73.87,100,,,,,0,"fee schedule","100% CMS fee schedule",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.02,65,,38.42,,,0,"percent of total billed charges","65% of total billed charges",32.58,27,,26.06,,,0,"percent of total billed charges","27% of total billed charges",70.18,95,,56.14,,,0,"percent of total billed charges","95% of total billed charges",73.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.01,88,,52.01,,,0,"percent of total billed charges","88% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",32.58,73.87,
"TRANS DERM SCOP 1.5MG PATCH",2720000692,CDM,250,RC,,,Outpatient,,,73.87,36.935,,73.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.14,76,,44.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.19,72,,42.55,,,0,"percent of total billed charges","72% of total billed charges",55.4,75,,44.32,,,0,"percent of total billed charges","75% of total billed charges",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.19,72,,42.55,,,0,"percent of total billed charges","72% of total billed charges",44.32,60,,35.46,,,0,"percent of total billed charges","60% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",33.24,45,,26.59,,,0,"percent of total billed charges","45% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",73.87,100,,,,,0,"fee schedule","100% CMS fee schedule",73.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.02,65,,38.42,,,0,"percent of total billed charges","65% of total billed charges",32.58,27,,26.06,,,0,"percent of total billed charges","27% of total billed charges",70.18,95,,56.14,,,0,"percent of total billed charges","95% of total billed charges",73.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.01,88,,52.01,,,0,"percent of total billed charges","88% of total billed charges",66.48,90,,53.18,,,0,"percent of total billed charges","90% of total billed charges",32.58,73.87,
"NIACIN 500MG TAB",2720000695,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"NIACIN 500MG TAB",2720000696,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"POLYVIT W/IRON LIQ.",2720000699,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"POLYVIT W/IRON LIQ.",2720000700,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"ZOCOR 20MG TAB",2720000703,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"ZOCOR 20MG TAB",2720000704,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"ZOCOR 40MG TAB",2720000707,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"ZOCOR 40MG TAB",2720000708,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"MIRALAX 17GM POWDER",2720000711,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MIRALAX 17GM POWDER",2720000712,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LIPITOR 20MG TAB",2720000715,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"LIPITOR 20MG TAB",2720000716,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"REQUIP 0.5MG TAB",2720000719,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"REQUIP 0.5MG TAB",2720000720,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PULMICORT 0.25MG NEB",2720000723,CDM,250,RC,,,Outpatient,,,766.24,383.12,,766.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",582.34,76,,465.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",551.69,72,,441.35,,,0,"percent of total billed charges","72% of total billed charges",574.68,75,,459.74,,,0,"percent of total billed charges","75% of total billed charges",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",551.69,72,,441.35,,,0,"percent of total billed charges","72% of total billed charges",459.74,60,,367.79,,,0,"percent of total billed charges","60% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",344.81,45,,275.85,,,0,"percent of total billed charges","45% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",766.24,100,,,,,0,"fee schedule","100% CMS fee schedule",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",498.06,65,,398.45,,,0,"percent of total billed charges","65% of total billed charges",337.91,27,,270.33,,,0,"percent of total billed charges","27% of total billed charges",727.93,95,,582.34,,,0,"percent of total billed charges","95% of total billed charges",766.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",674.29,88,,539.43,,,0,"percent of total billed charges","88% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",337.91,766.24,
"PULMICORT 0.25MG NEB",2720000724,CDM,250,RC,,,Outpatient,,,766.24,383.12,,766.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",582.34,76,,465.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",551.69,72,,441.35,,,0,"percent of total billed charges","72% of total billed charges",574.68,75,,459.74,,,0,"percent of total billed charges","75% of total billed charges",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",551.69,72,,441.35,,,0,"percent of total billed charges","72% of total billed charges",459.74,60,,367.79,,,0,"percent of total billed charges","60% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",344.81,45,,275.85,,,0,"percent of total billed charges","45% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",766.24,100,,,,,0,"fee schedule","100% CMS fee schedule",766.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",498.06,65,,398.45,,,0,"percent of total billed charges","65% of total billed charges",337.91,27,,270.33,,,0,"percent of total billed charges","27% of total billed charges",727.93,95,,582.34,,,0,"percent of total billed charges","95% of total billed charges",766.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",674.29,88,,539.43,,,0,"percent of total billed charges","88% of total billed charges",689.62,90,,551.70,,,0,"percent of total billed charges","90% of total billed charges",337.91,766.24,
"CIPRO HC OPHT SOLN",2720000727,CDM,250,RC,,,Outpatient,,,710.01,355.005,,710.01,125,,,,,0,"fee schedule","125% of CMS fee schedule",539.61,76,,431.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",511.21,72,,408.97,,,0,"percent of total billed charges","72% of total billed charges",532.51,75,,426.01,,,0,"percent of total billed charges","75% of total billed charges",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",511.21,72,,408.97,,,0,"percent of total billed charges","72% of total billed charges",426.01,60,,340.81,,,0,"percent of total billed charges","60% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",319.5,45,,255.60,,,0,"percent of total billed charges","45% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",710.01,100,,,,,0,"fee schedule","100% CMS fee schedule",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",461.51,65,,369.21,,,0,"percent of total billed charges","65% of total billed charges",313.11,27,,250.49,,,0,"percent of total billed charges","27% of total billed charges",674.51,95,,539.61,,,0,"percent of total billed charges","95% of total billed charges",710.01,75,,,,,0,"fee schedule","75% of CMS fee schedule",624.81,88,,499.85,,,0,"percent of total billed charges","88% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",313.11,710.01,
"CIPRO HC OPHT SOLN",2720000728,CDM,250,RC,,,Outpatient,,,710.01,355.005,,710.01,125,,,,,0,"fee schedule","125% of CMS fee schedule",539.61,76,,431.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",511.21,72,,408.97,,,0,"percent of total billed charges","72% of total billed charges",532.51,75,,426.01,,,0,"percent of total billed charges","75% of total billed charges",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",511.21,72,,408.97,,,0,"percent of total billed charges","72% of total billed charges",426.01,60,,340.81,,,0,"percent of total billed charges","60% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",319.5,45,,255.60,,,0,"percent of total billed charges","45% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",710.01,100,,,,,0,"fee schedule","100% CMS fee schedule",710.01,100,,,,,0,"fee schedule","100% of CMS fee schedule",461.51,65,,369.21,,,0,"percent of total billed charges","65% of total billed charges",313.11,27,,250.49,,,0,"percent of total billed charges","27% of total billed charges",674.51,95,,539.61,,,0,"percent of total billed charges","95% of total billed charges",710.01,75,,,,,0,"fee schedule","75% of CMS fee schedule",624.81,88,,499.85,,,0,"percent of total billed charges","88% of total billed charges",639.01,90,,511.21,,,0,"percent of total billed charges","90% of total billed charges",313.11,710.01,
"CIPROFLOXACIN 0.3 % OTRC SOLN",2720000731,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"CIPROFLOXACIN 0.3 % OTRC SOLN",2720000732,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"DILAUDID 2MG TAB",2720000735,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"DILAUDID 2MG TAB",2720000736,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"MICARDIS 40MG TAB",2720000739,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"MICARDIS 40MG TAB",2720000740,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"VOLTARENXR 100MG TAB",2720000743,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"VOLTARENXR 100MG TAB",2720000744,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"BLEPHLO OPHTH SOLN",2720000748,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"BLEPHLO OPHTH SOLN",2720000749,CDM,250,RC,,,Outpatient,,,90.41,45.205,,90.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",68.71,76,,54.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",67.81,75,,54.25,,,0,"percent of total billed charges","75% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.1,72,,52.08,,,0,"percent of total billed charges","72% of total billed charges",54.25,60,,43.40,,,0,"percent of total billed charges","60% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",40.68,45,,32.54,,,0,"percent of total billed charges","45% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% CMS fee schedule",90.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.77,65,,47.02,,,0,"percent of total billed charges","65% of total billed charges",39.87,27,,31.90,,,0,"percent of total billed charges","27% of total billed charges",85.89,95,,68.71,,,0,"percent of total billed charges","95% of total billed charges",90.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",79.56,88,,63.65,,,0,"percent of total billed charges","88% of total billed charges",81.37,90,,65.10,,,0,"percent of total billed charges","90% of total billed charges",39.87,90.41,
"LOTENSIN 40MG TAB",2720000752,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LOTENSIN 40MG TAB",2720000753,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ACTOS 15MG TAB",2720000756,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"ACTOS 15MG TAB",2720000757,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"ZOVIRAX 400MG TAB",2720000760,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ZOVIRAX 400MG TAB",2720000761,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"DURAGESIC 100MCG PATCH",2720000764,CDM,250,RC,,,Outpatient,,,616.3,308.15,,616.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",468.39,76,,374.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",443.74,72,,354.99,,,0,"percent of total billed charges","72% of total billed charges",462.23,75,,369.78,,,0,"percent of total billed charges","75% of total billed charges",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",443.74,72,,354.99,,,0,"percent of total billed charges","72% of total billed charges",369.78,60,,295.82,,,0,"percent of total billed charges","60% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",277.34,45,,221.87,,,0,"percent of total billed charges","45% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",616.3,100,,,,,0,"fee schedule","100% CMS fee schedule",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",400.6,65,,320.48,,,0,"percent of total billed charges","65% of total billed charges",271.79,27,,217.43,,,0,"percent of total billed charges","27% of total billed charges",585.49,95,,468.39,,,0,"percent of total billed charges","95% of total billed charges",616.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",542.34,88,,433.87,,,0,"percent of total billed charges","88% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",271.79,616.3,
"DURAGESIC 100MCG PATCH",2720000765,CDM,250,RC,,,Outpatient,,,616.3,308.15,,616.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",468.39,76,,374.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",443.74,72,,354.99,,,0,"percent of total billed charges","72% of total billed charges",462.23,75,,369.78,,,0,"percent of total billed charges","75% of total billed charges",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",443.74,72,,354.99,,,0,"percent of total billed charges","72% of total billed charges",369.78,60,,295.82,,,0,"percent of total billed charges","60% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",277.34,45,,221.87,,,0,"percent of total billed charges","45% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",616.3,100,,,,,0,"fee schedule","100% CMS fee schedule",616.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",400.6,65,,320.48,,,0,"percent of total billed charges","65% of total billed charges",271.79,27,,217.43,,,0,"percent of total billed charges","27% of total billed charges",585.49,95,,468.39,,,0,"percent of total billed charges","95% of total billed charges",616.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",542.34,88,,433.87,,,0,"percent of total billed charges","88% of total billed charges",554.67,90,,443.74,,,0,"percent of total billed charges","90% of total billed charges",271.79,616.3,
"GLUCOTROL XL 2.5 TAB",2720000768,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"GLUCOTROL XL 2.5 TAB",2720000769,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PRINIVIL 20MG TAB",2720000772,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PRINIVIL 20MG TAB",2720000773,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"PROTONIX 40MG TAB",2720000782,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"PROTONIX 40MG TAB",2720000783,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"MOBIC 7.5MG TAB",2720000786,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"MOBIC 7.5MG TAB",2720000787,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"VALTREX 500MG TAB",2720000791,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"VALTREX 500MG TAB",2720000792,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"ACTONEL 5MG TAB",2720000795,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"ACTONEL 5MG TAB",2720000796,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"MAVIK 2MG TAB",2720000799,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"MAVIK 2MG TAB",2720000800,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"DETROL LA 4MG CAP",2720000803,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"DETROL LA 4MG CAP",2720000804,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"GLUCOPHAGE XR 500MG",2720000807,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GLUCOPHAGE XR 500MG",2720000808,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"MONOPRIL 20MG TAB",2720000811,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"MONOPRIL 20MG TAB",2720000812,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"OXYCONTIN 20MG TAB",2720000815,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"OXYCONTIN 20MG TAB",2720000816,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"ESTRADIOL 1MG TAB",2720000819,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ESTRADIOL 1MG TAB",2720000820,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PLETAL 100MG TAB",2720000823,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PLETAL 100MG TAB",2720000824,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ROXANOL 20MG ML LIQUID",2720000827,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ROXANOL 20MG ML LIQUID",2720000828,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"OSCAL 500 TAB",2720000831,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"OSCAL 500 TAB",2720000832,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PEDI INFANT DECONG S",2720000835,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"PEDI INFANT DECONG S",2720000836,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"NAPROXEN 500MG TAB",2720000839,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"NAPROXEN 500MG TAB",2720000840,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ULTRACET 37.5/325 TAB",2720000843,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"ULTRACET 37.5/325 TAB",2720000844,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"EXELON 1.5MG CAP",2720000847,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"EXELON 1.5MG CAP",2720000848,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"TRICOR 54MG TAB",2720000851,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TRICOR 54MG TAB",2720000852,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"VIT D 400 UNIT CAP",2720000855,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"VIT D 400 UNIT CAP",2720000856,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LUMIGAN OPHT SOLN",2720000859,CDM,250,RC,,,Outpatient,,,471.87,235.935,,471.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",358.62,76,,286.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",339.75,72,,271.80,,,0,"percent of total billed charges","72% of total billed charges",353.9,75,,283.12,,,0,"percent of total billed charges","75% of total billed charges",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",339.75,72,,271.80,,,0,"percent of total billed charges","72% of total billed charges",283.12,60,,226.50,,,0,"percent of total billed charges","60% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",212.34,45,,169.87,,,0,"percent of total billed charges","45% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",471.87,100,,,,,0,"fee schedule","100% CMS fee schedule",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",306.72,65,,245.38,,,0,"percent of total billed charges","65% of total billed charges",208.09,27,,166.47,,,0,"percent of total billed charges","27% of total billed charges",448.28,95,,358.62,,,0,"percent of total billed charges","95% of total billed charges",471.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",415.25,88,,332.20,,,0,"percent of total billed charges","88% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",208.09,471.87,
"LUMIGAN OPHT SOLN",2720000860,CDM,250,RC,,,Outpatient,,,471.87,235.935,,471.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",358.62,76,,286.90,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",339.75,72,,271.80,,,0,"percent of total billed charges","72% of total billed charges",353.9,75,,283.12,,,0,"percent of total billed charges","75% of total billed charges",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",339.75,72,,271.80,,,0,"percent of total billed charges","72% of total billed charges",283.12,60,,226.50,,,0,"percent of total billed charges","60% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",212.34,45,,169.87,,,0,"percent of total billed charges","45% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",471.87,100,,,,,0,"fee schedule","100% CMS fee schedule",471.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",306.72,65,,245.38,,,0,"percent of total billed charges","65% of total billed charges",208.09,27,,166.47,,,0,"percent of total billed charges","27% of total billed charges",448.28,95,,358.62,,,0,"percent of total billed charges","95% of total billed charges",471.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",415.25,88,,332.20,,,0,"percent of total billed charges","88% of total billed charges",424.68,90,,339.74,,,0,"percent of total billed charges","90% of total billed charges",208.09,471.87,
"MORPHINE 15MG TAB",2720000863,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"MORPHINE 15MG TAB",2720000864,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ALPHAGAN 0.15% OPHTH SOLN",2720000867,CDM,250,RC,,,Outpatient,,,800.42,400.21,,800.42,125,,,,,0,"fee schedule","125% of CMS fee schedule",608.32,76,,486.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",576.3,72,,461.04,,,0,"percent of total billed charges","72% of total billed charges",600.32,75,,480.26,,,0,"percent of total billed charges","75% of total billed charges",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",576.3,72,,461.04,,,0,"percent of total billed charges","72% of total billed charges",480.25,60,,384.20,,,0,"percent of total billed charges","60% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",360.19,45,,288.15,,,0,"percent of total billed charges","45% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",800.42,100,,,,,0,"fee schedule","100% CMS fee schedule",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",520.27,65,,416.22,,,0,"percent of total billed charges","65% of total billed charges",352.99,27,,282.39,,,0,"percent of total billed charges","27% of total billed charges",760.4,95,,608.32,,,0,"percent of total billed charges","95% of total billed charges",800.42,75,,,,,0,"fee schedule","75% of CMS fee schedule",704.37,88,,563.50,,,0,"percent of total billed charges","88% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",352.99,800.42,
"ALPHAGAN 0.15% OPHTH SOLN",2720000868,CDM,250,RC,,,Outpatient,,,800.42,400.21,,800.42,125,,,,,0,"fee schedule","125% of CMS fee schedule",608.32,76,,486.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",576.3,72,,461.04,,,0,"percent of total billed charges","72% of total billed charges",600.32,75,,480.26,,,0,"percent of total billed charges","75% of total billed charges",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",576.3,72,,461.04,,,0,"percent of total billed charges","72% of total billed charges",480.25,60,,384.20,,,0,"percent of total billed charges","60% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",360.19,45,,288.15,,,0,"percent of total billed charges","45% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",800.42,100,,,,,0,"fee schedule","100% CMS fee schedule",800.42,100,,,,,0,"fee schedule","100% of CMS fee schedule",520.27,65,,416.22,,,0,"percent of total billed charges","65% of total billed charges",352.99,27,,282.39,,,0,"percent of total billed charges","27% of total billed charges",760.4,95,,608.32,,,0,"percent of total billed charges","95% of total billed charges",800.42,75,,,,,0,"fee schedule","75% of CMS fee schedule",704.37,88,,563.50,,,0,"percent of total billed charges","88% of total billed charges",720.38,90,,576.30,,,0,"percent of total billed charges","90% of total billed charges",352.99,800.42,
"ALTACE 1.25MG CAP",2720000871,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ALTACE 1.25MG CAP",2720000872,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"FOSAMAX 70MG TAB",2720000875,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"FOSAMAX 70MG TAB",2720000876,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"STARLIX 120MG TAB",2720000879,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"STARLIX 120MG TAB",2720000880,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"DICLOXACILLIN 500MG TAB",2720000883,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"DICLOXACILLIN 500MG TAB",2720000884,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"MICARDIS 80MG TAB",2720000887,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"MICARDIS 80MG TAB",2720000888,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"RENAGEL 800MG TAB",2720000891,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"RENAGEL 800MG TAB",2720000892,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"PREPERATION H OINT",2720000895,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"PREPERATION H OINT",2720000896,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"NYSTATIN 10000 OINT",2720000899,CDM,250,RC,,,Outpatient,,,81.59,40.795,,81.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.01,76,,49.61,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",58.74,72,,46.99,,,0,"percent of total billed charges","72% of total billed charges",61.19,75,,48.95,,,0,"percent of total billed charges","75% of total billed charges",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.74,72,,46.99,,,0,"percent of total billed charges","72% of total billed charges",48.95,60,,39.16,,,0,"percent of total billed charges","60% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",36.72,45,,29.38,,,0,"percent of total billed charges","45% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",81.59,100,,,,,0,"fee schedule","100% CMS fee schedule",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.03,65,,42.42,,,0,"percent of total billed charges","65% of total billed charges",35.98,27,,28.78,,,0,"percent of total billed charges","27% of total billed charges",77.51,95,,62.01,,,0,"percent of total billed charges","95% of total billed charges",81.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",71.8,88,,57.44,,,0,"percent of total billed charges","88% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",35.98,81.59,
"NYSTATIN 10000 OINT",2720000900,CDM,250,RC,,,Outpatient,,,81.59,40.795,,81.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.01,76,,49.61,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",58.74,72,,46.99,,,0,"percent of total billed charges","72% of total billed charges",61.19,75,,48.95,,,0,"percent of total billed charges","75% of total billed charges",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.74,72,,46.99,,,0,"percent of total billed charges","72% of total billed charges",48.95,60,,39.16,,,0,"percent of total billed charges","60% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",36.72,45,,29.38,,,0,"percent of total billed charges","45% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",81.59,100,,,,,0,"fee schedule","100% CMS fee schedule",81.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.03,65,,42.42,,,0,"percent of total billed charges","65% of total billed charges",35.98,27,,28.78,,,0,"percent of total billed charges","27% of total billed charges",77.51,95,,62.01,,,0,"percent of total billed charges","95% of total billed charges",81.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",71.8,88,,57.44,,,0,"percent of total billed charges","88% of total billed charges",73.43,90,,58.74,,,0,"percent of total billed charges","90% of total billed charges",35.98,81.59,
"SINGULAIR 5MG TAB",2720000903,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"SINGULAIR 5MG TAB",2720000904,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"UROCIT K TAB",2720000907,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"UROCIT K TAB",2720000908,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"FERROUS GLUCONATE 30",2720000911,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FERROUS GLUCONATE 30",2720000912,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LORTAB 10/650 TAB",2720000915,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LORTAB 10/650 TAB",2720000916,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GALANTAMINE 8MG TAB",2720000919,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"GALANTAMINE 8MG TAB",2720000920,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"XOPENEX 0.31MG NEB",2720000923,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.79,20.395,U8,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",1.48,40.79,
"XOPENEX 0.31MG NEB",2720000924,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.79,20.395,U8,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",1.48,40.79,
"XOPENEX 1.25MG NEB",2720000927,CDM,250,RC,,,Outpatient,,,40.79,20.395,,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",30.59,75,,24.47,,,0,"percent of total billed charges","75% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",24.47,60,,19.58,,,0,"percent of total billed charges","60% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,14.39,,,0,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",17.99,40.79,
"XOPENEX 1.25MG NEB",2720000928,CDM,250,RC,,,Outpatient,,,40.79,20.395,,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",30.59,75,,24.47,,,0,"percent of total billed charges","75% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",24.47,60,,19.58,,,0,"percent of total billed charges","60% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,14.39,,,0,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",17.99,40.79,
"ACCUNEB 1.25MG/3ML NEB",2720000931,CDM,250,RC,J7614,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",1.48,9.92,
"ACCUNEB 1.25MG/3ML NEB",2720000932,CDM,250,RC,J7614,HCPCS,Outpatient,,,9.92,4.96,U8,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.18,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.18,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.48,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,5.44,4.89,8.60,14,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",1.48,9.92,
"AUGMENTIN XR 1000 TAB",2720000935,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"AUGMENTIN XR 1000 TAB",2720000936,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"COMTAN 200MG TAB",2720000939,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"COMTAN 200MG TAB",2720000940,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"NORCO 10/325 TAB",2720000943,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"NORCO 10/325 TAB",2720000944,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"PAXIL CR 12.5MG TAB",2720000947,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"PAXIL CR 12.5MG TAB",2720000948,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"ACTONEL 35MG TAB",2720000951,CDM,250,RC,,,Outpatient,,,126.79,63.395,,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,44.73,,,0,"percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.58,88,,89.26,,,0,"percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"ACTONEL 35MG TAB",2720000952,CDM,250,RC,,,Outpatient,,,126.79,63.395,,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,44.73,,,0,"percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.58,88,,89.26,,,0,"percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"TEGRETOL XR 200MG TAB",2720000955,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"TEGRETOL XR 200MG TAB",2720000956,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ABILIFY 10MG TAB",2720000959,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"ABILIFY 10MG TAB",2720000960,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"ARIMIDEX 1MG TAB",2720000963,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"ARIMIDEX 1MG TAB",2720000964,CDM,250,RC,,,Outpatient,,,62.84,31.42,,62.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",47.76,76,,38.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",47.13,75,,37.70,,,0,"percent of total billed charges","75% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.24,72,,36.19,,,0,"percent of total billed charges","72% of total billed charges",37.7,60,,30.16,,,0,"percent of total billed charges","60% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",28.28,45,,22.62,,,0,"percent of total billed charges","45% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% CMS fee schedule",62.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.85,65,,32.68,,,0,"percent of total billed charges","65% of total billed charges",27.71,27,,22.17,,,0,"percent of total billed charges","27% of total billed charges",59.7,95,,47.76,,,0,"percent of total billed charges","95% of total billed charges",62.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",55.3,88,,44.24,,,0,"percent of total billed charges","88% of total billed charges",56.56,90,,45.25,,,0,"percent of total billed charges","90% of total billed charges",27.71,62.84,
"FOLIC ACID 0.4MG TAB",2720000967,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FOLIC ACID 0.4MG TAB",2720000968,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"HIPREX 1G TAB",2720000971,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"HIPREX 1G TAB",2720000972,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"RESTASIS 0.05% OPHTH SOLN",2720000975,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"RESTASIS 0.05% OPHTH SOLN",2720000976,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"LEXAPRO 10MG TAB",2720000979,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"LEXAPRO 10MG TAB",2720000980,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"ZETIA 10MG TAB",2720000983,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"ZETIA 10MG TAB",2720000984,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"OMNICEF 125/5ML ORAL SUSP",2720000987,CDM,250,RC,,,Outpatient,,,325.24,162.62,,325.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",247.18,76,,197.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",243.93,75,,195.14,,,0,"percent of total billed charges","75% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",195.14,60,,156.11,,,0,"percent of total billed charges","60% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",146.36,45,,117.09,,,0,"percent of total billed charges","45% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.41,65,,169.13,,,0,"percent of total billed charges","65% of total billed charges",143.43,27,,114.74,,,0,"percent of total billed charges","27% of total billed charges",308.98,95,,247.18,,,0,"percent of total billed charges","95% of total billed charges",325.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",286.21,88,,228.97,,,0,"percent of total billed charges","88% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",143.43,325.24,
"OMNICEF 125/5ML ORAL SUSP",2720000988,CDM,250,RC,,,Outpatient,,,325.24,162.62,,325.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",247.18,76,,197.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",243.93,75,,195.14,,,0,"percent of total billed charges","75% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.17,72,,187.34,,,0,"percent of total billed charges","72% of total billed charges",195.14,60,,156.11,,,0,"percent of total billed charges","60% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",146.36,45,,117.09,,,0,"percent of total billed charges","45% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% CMS fee schedule",325.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.41,65,,169.13,,,0,"percent of total billed charges","65% of total billed charges",143.43,27,,114.74,,,0,"percent of total billed charges","27% of total billed charges",308.98,95,,247.18,,,0,"percent of total billed charges","95% of total billed charges",325.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",286.21,88,,228.97,,,0,"percent of total billed charges","88% of total billed charges",292.72,90,,234.18,,,0,"percent of total billed charges","90% of total billed charges",143.43,325.24,
"NAMENDA 10MG TAB",2720000991,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"NAMENDA 10MG TAB",2720000992,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"TRILEPTAL 300MG TAB",2720000995,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"TRILEPTAL 300MG TAB",2720000996,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"FORADIL 12MCG CAP",2720000999,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"FORADIL 12MCG CAP",2720001000,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"SEROQUEL 25MG TAB",2720001003,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"SEROQUEL 25MG TAB",2720001004,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"SPIRIVA 18MCG CAP",2720001007,CDM,250,RC,,,Outpatient,,,52.92,26.46,,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",39.69,75,,31.75,,,0,"percent of total billed charges","75% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",31.75,60,,25.40,,,0,"percent of total billed charges","60% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,18.67,,,0,"percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,37.26,,,0,"percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.34,52.92,
"SPIRIVA 18MCG CAP",2720001008,CDM,250,RC,,,Outpatient,,,52.92,26.46,,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",39.69,75,,31.75,,,0,"percent of total billed charges","75% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",31.75,60,,25.40,,,0,"percent of total billed charges","60% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,18.67,,,0,"percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,37.26,,,0,"percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.34,52.92,
"EFFEXOR XR 75MG CAP",2720001011,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"EFFEXOR XR 75MG CAP",2720001012,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"PLAN B 0.75MG TABS",2720001015,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"PLAN B 0.75MG TABS",2720001016,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"RISPERDALM 0.5MG TA",2720001019,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"RISPERDALM 0.5MG TA",2720001020,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"TARKA 4240 TAB",2720001023,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"TARKA 4240 TAB",2720001024,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"WELLBUTRIN XL 150MG",2720001027,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"WELLBUTRIN XL 150MG",2720001028,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"CONSTULOSE 10MG/15ML ORAL SUSP",2720001031,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"CONSTULOSE 10MG/15ML ORAL SUSP",2720001032,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"ALBUTEROL 2.5MG/0.5ML NEB",2720001035,CDM,250,RC,J7613,HCPCS,Outpatient,,,79.38,39.69,U8,79.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",60.33,76,,48.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.28,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.28,350,,0.07,0.06,0.08,"1 through 10","fee schedule","350% of BCBS fee schedule",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.28,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.08,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",71.44,90,,9.72,8.86,27.86,"1 through 10","percent of total billed charges","90% of total billed charges",35.72,45,,28.58,,,0,"percent of total billed charges","45% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% CMS fee schedule",79.38,100,,0.33,0.22,0.57,"1 through 10","fee schedule","100% of CMS fee schedule",51.6,65,,41.28,,,0,"percent of total billed charges","65% of total billed charges",35.01,27,,8.60,4.89,14.94,80,"percent of total billed charges","27% of total billed charges",75.41,95,,60.33,,,0,"percent of total billed charges","95% of total billed charges",79.38,75,,0.16,0.16,0.16,"1 through 10","fee schedule","75% of CMS fee schedule",69.85,88,,55.88,,,0,"percent of total billed charges","88% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",0.08,79.38,
"ALBUTEROL 2.5MG/0.5ML NEB",2720001036,CDM,250,RC,J7613,HCPCS,Outpatient,,,79.38,39.69,U8,79.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",60.33,76,,48.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.28,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.28,350,,0.07,0.06,0.08,"1 through 10","fee schedule","350% of BCBS fee schedule",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.28,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.08,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",71.44,90,,9.72,8.86,27.86,"1 through 10","percent of total billed charges","90% of total billed charges",35.72,45,,28.58,,,0,"percent of total billed charges","45% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% CMS fee schedule",79.38,100,,0.33,0.22,0.57,"1 through 10","fee schedule","100% of CMS fee schedule",51.6,65,,41.28,,,0,"percent of total billed charges","65% of total billed charges",35.01,27,,8.60,4.89,14.94,80,"percent of total billed charges","27% of total billed charges",75.41,95,,60.33,,,0,"percent of total billed charges","95% of total billed charges",79.38,75,,0.16,0.16,0.16,"1 through 10","fee schedule","75% of CMS fee schedule",69.85,88,,55.88,,,0,"percent of total billed charges","88% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",0.08,79.38,
"PHENOBARB 20MG/5ML SOLN",2720001039,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PHENOBARB 20MG/5ML SOLN",2720001040,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TRICOR 145MG TAB",2720001043,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"TRICOR 145MG TAB",2720001044,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"MEGACE 400MG/10ML SUSP",2720001047,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"MEGACE 400MG/10ML SUSP",2720001048,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"AVODART 0.5MG CAP",2720001051,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"AVODART 0.5MG CAP",2720001052,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"CARAFATE 1GM/10ML SUSP",2720001055,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"CARAFATE 1GM/10ML SUSP",2720001056,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"CIPRODEX OPHTH SOLN",2720001059,CDM,250,RC,,,Outpatient,,,649.37,324.685,,649.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",493.52,76,,394.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",467.55,72,,374.04,,,0,"percent of total billed charges","72% of total billed charges",487.03,75,,389.62,,,0,"percent of total billed charges","75% of total billed charges",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",467.55,72,,374.04,,,0,"percent of total billed charges","72% of total billed charges",389.62,60,,311.70,,,0,"percent of total billed charges","60% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",292.22,45,,233.78,,,0,"percent of total billed charges","45% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",649.37,100,,,,,0,"fee schedule","100% CMS fee schedule",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",422.09,65,,337.67,,,0,"percent of total billed charges","65% of total billed charges",286.37,27,,229.10,,,0,"percent of total billed charges","27% of total billed charges",616.9,95,,493.52,,,0,"percent of total billed charges","95% of total billed charges",649.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",571.45,88,,457.16,,,0,"percent of total billed charges","88% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",286.37,649.37,
"CIPRODEX OPHTH SOLN",2720001060,CDM,250,RC,,,Outpatient,,,649.37,324.685,,649.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",493.52,76,,394.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",467.55,72,,374.04,,,0,"percent of total billed charges","72% of total billed charges",487.03,75,,389.62,,,0,"percent of total billed charges","75% of total billed charges",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",467.55,72,,374.04,,,0,"percent of total billed charges","72% of total billed charges",389.62,60,,311.70,,,0,"percent of total billed charges","60% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",292.22,45,,233.78,,,0,"percent of total billed charges","45% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",649.37,100,,,,,0,"fee schedule","100% CMS fee schedule",649.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",422.09,65,,337.67,,,0,"percent of total billed charges","65% of total billed charges",286.37,27,,229.10,,,0,"percent of total billed charges","27% of total billed charges",616.9,95,,493.52,,,0,"percent of total billed charges","95% of total billed charges",649.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",571.45,88,,457.16,,,0,"percent of total billed charges","88% of total billed charges",584.43,90,,467.54,,,0,"percent of total billed charges","90% of total billed charges",286.37,649.37,
"AUGMENT 600MG/5ML ORAL SUSP",2720001063,CDM,250,RC,,,Outpatient,,,233.73,116.865,,233.73,125,,,,,0,"fee schedule","125% of CMS fee schedule",177.63,76,,142.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",168.29,72,,134.63,,,0,"percent of total billed charges","72% of total billed charges",175.3,75,,140.24,,,0,"percent of total billed charges","75% of total billed charges",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",168.29,72,,134.63,,,0,"percent of total billed charges","72% of total billed charges",140.24,60,,112.19,,,0,"percent of total billed charges","60% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",105.18,45,,84.14,,,0,"percent of total billed charges","45% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.73,100,,,,,0,"fee schedule","100% CMS fee schedule",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",151.92,65,,121.54,,,0,"percent of total billed charges","65% of total billed charges",103.07,27,,82.46,,,0,"percent of total billed charges","27% of total billed charges",222.04,95,,177.63,,,0,"percent of total billed charges","95% of total billed charges",233.73,75,,,,,0,"fee schedule","75% of CMS fee schedule",205.68,88,,164.54,,,0,"percent of total billed charges","88% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",103.07,233.73,
"AUGMENT 600MG/5ML ORAL SUSP",2720001064,CDM,250,RC,,,Outpatient,,,233.73,116.865,,233.73,125,,,,,0,"fee schedule","125% of CMS fee schedule",177.63,76,,142.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",168.29,72,,134.63,,,0,"percent of total billed charges","72% of total billed charges",175.3,75,,140.24,,,0,"percent of total billed charges","75% of total billed charges",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",168.29,72,,134.63,,,0,"percent of total billed charges","72% of total billed charges",140.24,60,,112.19,,,0,"percent of total billed charges","60% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",105.18,45,,84.14,,,0,"percent of total billed charges","45% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",233.73,100,,,,,0,"fee schedule","100% CMS fee schedule",233.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",151.92,65,,121.54,,,0,"percent of total billed charges","65% of total billed charges",103.07,27,,82.46,,,0,"percent of total billed charges","27% of total billed charges",222.04,95,,177.63,,,0,"percent of total billed charges","95% of total billed charges",233.73,75,,,,,0,"fee schedule","75% of CMS fee schedule",205.68,88,,164.54,,,0,"percent of total billed charges","88% of total billed charges",210.36,90,,168.29,,,0,"percent of total billed charges","90% of total billed charges",103.07,233.73,
"ROBITUSSIN DM 5ML UD",2720001067,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"ROBITUSSIN DM 5ML UD",2720001068,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"FEMARA 2.5MG TAB",2720001071,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"FEMARA 2.5MG TAB",2720001072,CDM,250,RC,,,Outpatient,,,77.18,38.59,,77.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",58.66,76,,46.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",57.89,75,,46.31,,,0,"percent of total billed charges","75% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.57,72,,44.46,,,0,"percent of total billed charges","72% of total billed charges",46.31,60,,37.05,,,0,"percent of total billed charges","60% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.73,45,,27.78,,,0,"percent of total billed charges","45% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% CMS fee schedule",77.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.17,65,,40.14,,,0,"percent of total billed charges","65% of total billed charges",34.04,27,,27.23,,,0,"percent of total billed charges","27% of total billed charges",73.32,95,,58.66,,,0,"percent of total billed charges","95% of total billed charges",77.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",67.92,88,,54.34,,,0,"percent of total billed charges","88% of total billed charges",69.46,90,,55.57,,,0,"percent of total billed charges","90% of total billed charges",34.04,77.18,
"LIDODERM 5% PATCH",2720001075,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"LIDODERM 5% PATCH",2720001076,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"LANOXIN 0.05MG/ML SOLN",2720001079,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LANOXIN 0.05MG/ML SOLN",2720001080,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"BENADRYL 25MG/10 ML UD ELIXIR",2720001083,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"BENADRYL 25MG/10 ML UD ELIXIR",2720001084,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NYSTATIN 5ML ORAL SUSP",2720001087,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"NYSTATIN 5ML ORAL SUSP",2720001088,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ISOPTO HYOSCINE 0.25% SOLN",2720001091,CDM,250,RC,,,Outpatient,,,147.74,73.87,,147.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",112.28,76,,89.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",106.37,72,,85.10,,,0,"percent of total billed charges","72% of total billed charges",110.81,75,,88.65,,,0,"percent of total billed charges","75% of total billed charges",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.37,72,,85.10,,,0,"percent of total billed charges","72% of total billed charges",88.64,60,,70.91,,,0,"percent of total billed charges","60% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",66.48,45,,53.18,,,0,"percent of total billed charges","45% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",147.74,100,,,,,0,"fee schedule","100% CMS fee schedule",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",96.03,65,,76.82,,,0,"percent of total billed charges","65% of total billed charges",65.15,27,,52.12,,,0,"percent of total billed charges","27% of total billed charges",140.35,95,,112.28,,,0,"percent of total billed charges","95% of total billed charges",147.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",130.01,88,,104.01,,,0,"percent of total billed charges","88% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",65.15,147.74,
"ISOPTO HYOSCINE 0.25% SOLN",2720001092,CDM,250,RC,,,Outpatient,,,147.74,73.87,,147.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",112.28,76,,89.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",106.37,72,,85.10,,,0,"percent of total billed charges","72% of total billed charges",110.81,75,,88.65,,,0,"percent of total billed charges","75% of total billed charges",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.37,72,,85.10,,,0,"percent of total billed charges","72% of total billed charges",88.64,60,,70.91,,,0,"percent of total billed charges","60% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",66.48,45,,53.18,,,0,"percent of total billed charges","45% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",147.74,100,,,,,0,"fee schedule","100% CMS fee schedule",147.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",96.03,65,,76.82,,,0,"percent of total billed charges","65% of total billed charges",65.15,27,,52.12,,,0,"percent of total billed charges","27% of total billed charges",140.35,95,,112.28,,,0,"percent of total billed charges","95% of total billed charges",147.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",130.01,88,,104.01,,,0,"percent of total billed charges","88% of total billed charges",132.97,90,,106.38,,,0,"percent of total billed charges","90% of total billed charges",65.15,147.74,
"PULMICORT 0.5MG/2ML NEB",2720001095,CDM,250,RC,J7626,HCPCS,Outpatient,,,48.51,24.255,U8,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.33,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",22.33,350,,,,,0,"fee schedule","350% of BCBS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.33,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",6.38,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,1.35,1.29,1.40,"1 through 10","fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,27.92,20.33,43.28,"1 through 10","percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",6.38,48.51,
"PULMICORT 0.5MG/2ML NEB",2720001096,CDM,250,RC,J7626,HCPCS,Outpatient,,,48.51,24.255,U8,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.33,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",22.33,350,,,,,0,"fee schedule","350% of BCBS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.33,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",6.38,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,1.35,1.29,1.40,"1 through 10","fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,27.92,20.33,43.28,"1 through 10","percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",6.38,48.51,
"ZIOX 405 OINTMENT",2720001099,CDM,250,RC,,,Outpatient,,,266.81,133.405,,266.81,125,,,,,0,"fee schedule","125% of CMS fee schedule",202.78,76,,162.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",200.11,75,,160.09,,,0,"percent of total billed charges","75% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",160.09,60,,128.07,,,0,"percent of total billed charges","60% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",120.06,45,,96.05,,,0,"percent of total billed charges","45% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.43,65,,138.74,,,0,"percent of total billed charges","65% of total billed charges",117.66,27,,94.13,,,0,"percent of total billed charges","27% of total billed charges",253.47,95,,202.78,,,0,"percent of total billed charges","95% of total billed charges",266.81,75,,,,,0,"fee schedule","75% of CMS fee schedule",234.79,88,,187.83,,,0,"percent of total billed charges","88% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",117.66,266.81,
"ZIOX 405 OINTMENT",2720001100,CDM,250,RC,,,Outpatient,,,266.81,133.405,,266.81,125,,,,,0,"fee schedule","125% of CMS fee schedule",202.78,76,,162.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",200.11,75,,160.09,,,0,"percent of total billed charges","75% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.1,72,,153.68,,,0,"percent of total billed charges","72% of total billed charges",160.09,60,,128.07,,,0,"percent of total billed charges","60% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",120.06,45,,96.05,,,0,"percent of total billed charges","45% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% CMS fee schedule",266.81,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.43,65,,138.74,,,0,"percent of total billed charges","65% of total billed charges",117.66,27,,94.13,,,0,"percent of total billed charges","27% of total billed charges",253.47,95,,202.78,,,0,"percent of total billed charges","95% of total billed charges",266.81,75,,,,,0,"fee schedule","75% of CMS fee schedule",234.79,88,,187.83,,,0,"percent of total billed charges","88% of total billed charges",240.13,90,,192.10,,,0,"percent of total billed charges","90% of total billed charges",117.66,266.81,
"VAGISIL CREAM",2720001103,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"VAGISIL CREAM",2720001104,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"OMNICEF 250/5 ORAL SUSP",2720001107,CDM,250,RC,,,Outpatient,,,380.36,190.18,,380.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",289.07,76,,231.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",273.86,72,,219.09,,,0,"percent of total billed charges","72% of total billed charges",285.27,75,,228.22,,,0,"percent of total billed charges","75% of total billed charges",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",273.86,72,,219.09,,,0,"percent of total billed charges","72% of total billed charges",228.22,60,,182.58,,,0,"percent of total billed charges","60% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",171.16,45,,136.93,,,0,"percent of total billed charges","45% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",380.36,100,,,,,0,"fee schedule","100% CMS fee schedule",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",247.23,65,,197.78,,,0,"percent of total billed charges","65% of total billed charges",167.74,27,,134.19,,,0,"percent of total billed charges","27% of total billed charges",361.34,95,,289.07,,,0,"percent of total billed charges","95% of total billed charges",380.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",334.72,88,,267.78,,,0,"percent of total billed charges","88% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",167.74,380.36,
"OMNICEF 250/5 ORAL SUSP",2720001108,CDM,250,RC,,,Outpatient,,,380.36,190.18,,380.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",289.07,76,,231.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",273.86,72,,219.09,,,0,"percent of total billed charges","72% of total billed charges",285.27,75,,228.22,,,0,"percent of total billed charges","75% of total billed charges",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",273.86,72,,219.09,,,0,"percent of total billed charges","72% of total billed charges",228.22,60,,182.58,,,0,"percent of total billed charges","60% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",171.16,45,,136.93,,,0,"percent of total billed charges","45% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",380.36,100,,,,,0,"fee schedule","100% CMS fee schedule",380.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",247.23,65,,197.78,,,0,"percent of total billed charges","65% of total billed charges",167.74,27,,134.19,,,0,"percent of total billed charges","27% of total billed charges",361.34,95,,289.07,,,0,"percent of total billed charges","95% of total billed charges",380.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",334.72,88,,267.78,,,0,"percent of total billed charges","88% of total billed charges",342.32,90,,273.86,,,0,"percent of total billed charges","90% of total billed charges",167.74,380.36,
"LITTLE NOSES SALINE",2720001111,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"LITTLE NOSES SALINE",2720001112,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"COREG 25MG TAB",2720001115,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREG 25MG TAB",2720001116,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TYLENOL W/CODEINE TAB 4S",2720001119,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"TYLENOL W/CODEINE TAB 4S",2720001120,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"TYLENOL W/CODEINE TAB 4E",2720001123,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"TYLENOL W/CODEINE TAB 4E",2720001124,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"VENTOLIN INHALER (E)",2720001127,CDM,250,RC,,,Outpatient,,,149.94,74.97,,149.94,125,,,,,0,"fee schedule","125% of CMS fee schedule",113.95,76,,91.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",107.96,72,,86.37,,,0,"percent of total billed charges","72% of total billed charges",112.46,75,,89.97,,,0,"percent of total billed charges","75% of total billed charges",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",107.96,72,,86.37,,,0,"percent of total billed charges","72% of total billed charges",89.96,60,,71.97,,,0,"percent of total billed charges","60% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",67.47,45,,53.98,,,0,"percent of total billed charges","45% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",149.94,100,,,,,0,"fee schedule","100% CMS fee schedule",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.46,65,,77.97,,,0,"percent of total billed charges","65% of total billed charges",66.12,27,,52.90,,,0,"percent of total billed charges","27% of total billed charges",142.44,95,,113.95,,,0,"percent of total billed charges","95% of total billed charges",149.94,75,,,,,0,"fee schedule","75% of CMS fee schedule",131.95,88,,105.56,,,0,"percent of total billed charges","88% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",66.12,149.94,
"VENTOLIN INHALER (E)",2720001128,CDM,250,RC,,,Outpatient,,,149.94,74.97,,149.94,125,,,,,0,"fee schedule","125% of CMS fee schedule",113.95,76,,91.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",107.96,72,,86.37,,,0,"percent of total billed charges","72% of total billed charges",112.46,75,,89.97,,,0,"percent of total billed charges","75% of total billed charges",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",107.96,72,,86.37,,,0,"percent of total billed charges","72% of total billed charges",89.96,60,,71.97,,,0,"percent of total billed charges","60% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",67.47,45,,53.98,,,0,"percent of total billed charges","45% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",149.94,100,,,,,0,"fee schedule","100% CMS fee schedule",149.94,100,,,,,0,"fee schedule","100% of CMS fee schedule",97.46,65,,77.97,,,0,"percent of total billed charges","65% of total billed charges",66.12,27,,52.90,,,0,"percent of total billed charges","27% of total billed charges",142.44,95,,113.95,,,0,"percent of total billed charges","95% of total billed charges",149.94,75,,,,,0,"fee schedule","75% of CMS fee schedule",131.95,88,,105.56,,,0,"percent of total billed charges","88% of total billed charges",134.95,90,,107.96,,,0,"percent of total billed charges","90% of total billed charges",66.12,149.94,
"VENTOLIN INHALER (S)",2720001131,CDM,250,RC,,,Outpatient,,,173.09,86.545,,173.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",131.55,76,,105.24,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",124.62,72,,99.70,,,0,"percent of total billed charges","72% of total billed charges",129.82,75,,103.86,,,0,"percent of total billed charges","75% of total billed charges",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.62,72,,99.70,,,0,"percent of total billed charges","72% of total billed charges",103.85,60,,83.08,,,0,"percent of total billed charges","60% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",77.89,45,,62.31,,,0,"percent of total billed charges","45% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.09,100,,,,,0,"fee schedule","100% CMS fee schedule",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.51,65,,90.01,,,0,"percent of total billed charges","65% of total billed charges",76.33,27,,61.06,,,0,"percent of total billed charges","27% of total billed charges",164.44,95,,131.55,,,0,"percent of total billed charges","95% of total billed charges",173.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",152.32,88,,121.86,,,0,"percent of total billed charges","88% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",76.33,173.09,
"VENTOLIN INHALER (S)",2720001132,CDM,250,RC,,,Outpatient,,,173.09,86.545,,173.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",131.55,76,,105.24,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",124.62,72,,99.70,,,0,"percent of total billed charges","72% of total billed charges",129.82,75,,103.86,,,0,"percent of total billed charges","75% of total billed charges",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.62,72,,99.70,,,0,"percent of total billed charges","72% of total billed charges",103.85,60,,83.08,,,0,"percent of total billed charges","60% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",77.89,45,,62.31,,,0,"percent of total billed charges","45% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",173.09,100,,,,,0,"fee schedule","100% CMS fee schedule",173.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.51,65,,90.01,,,0,"percent of total billed charges","65% of total billed charges",76.33,27,,61.06,,,0,"percent of total billed charges","27% of total billed charges",164.44,95,,131.55,,,0,"percent of total billed charges","95% of total billed charges",173.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",152.32,88,,121.86,,,0,"percent of total billed charges","88% of total billed charges",155.78,90,,124.62,,,0,"percent of total billed charges","90% of total billed charges",76.33,173.09,
"AMOXIL 250MG CAP (E) 4",2720001135,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"AMOXIL 250MG CAP (E) 4",2720001136,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"AMOXIL 250MG CAP (S) 4",2720001139,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AMOXIL 250MG CAP (S) 4",2720001140,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AMOXIL 125MG/5ML SUS E 100ML",2720001143,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"AMOXIL 125MG/5ML SUS E 100ML",2720001144,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"AMOXIL 125MG/5ML SUS S 100ML",2720001147,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"AMOXIL 125MG/5ML SUS S 100ML",2720001148,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"AMOXIL 250MG/5ML SUS E 100ML",2720001151,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"AMOXIL 250MG/5ML SUS E 100ML",2720001152,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"AMOXIL 250MG/5ML SUS S 100ML",2720001155,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"AMOXIL 250MG/5ML SUS S 100ML",2720001156,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"KEFLEX 250MG CAP (S)",2720001159,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"KEFLEX 250MG CAP (S)",2720001160,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"KEFLEX 125MG/5ML SUS",2720001163,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"KEFLEX 125MG/5ML SUS",2720001164,CDM,250,RC,,,Outpatient,,,35.28,17.64,,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,21.45,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,12.45,,,0,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.05,88,,24.84,,,0,"percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"VIBRAMYCIN 100MG TAB",2720001167,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"VIBRAMYCIN 100MG TAB",2720001168,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"BACTRIM DS TABS (E) 2",2720001171,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BACTRIM DS TABS (E) 2",2720001172,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BACTRIM DS TABS (S) 2",2720001175,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BACTRIM DS TABS (S) 2",2720001176,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"MIRAPEX 1MG TAB",2720001179,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"MIRAPEX 1MG TAB",2720001180,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"KEFLEX 250/5 SUSP (E",2720001183,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"KEFLEX 250/5 SUSP (E",2720001184,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"TYLENOL W/CODN ELX(E 60ML",2720001187,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TYLENOL W/CODN ELX(E 60ML",2720001188,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TYLENOL W/CODN ELX(S 60ML",2720001191,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"TYLENOL W/CODN ELX(S 60ML",2720001192,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"LYRICA 75MG TAB",2720001195,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"LYRICA 75MG TAB",2720001196,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"KEFLEX 250/5 (S)",2720001199,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"KEFLEX 250/5 (S)",2720001200,CDM,250,RC,,,Outpatient,,,50.72,25.36,,50.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",38.55,76,,30.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",38.04,75,,30.43,,,0,"percent of total billed charges","75% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.52,72,,29.22,,,0,"percent of total billed charges","72% of total billed charges",30.43,60,,24.34,,,0,"percent of total billed charges","60% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.82,45,,18.26,,,0,"percent of total billed charges","45% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% CMS fee schedule",50.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.97,65,,26.38,,,0,"percent of total billed charges","65% of total billed charges",22.37,27,,17.90,,,0,"percent of total billed charges","27% of total billed charges",48.18,95,,38.54,,,0,"percent of total billed charges","95% of total billed charges",50.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",44.63,88,,35.70,,,0,"percent of total billed charges","88% of total billed charges",45.65,90,,36.52,,,0,"percent of total billed charges","90% of total billed charges",22.37,50.72,
"MIRAPEX 0.25MG TAB",2720001203,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"MIRAPEX 0.25MG TAB",2720001204,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"PROTONIX 20MG TABLET",2720001223,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROTONIX 20MG TABLET",2720001224,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CELLCEPT 500MG TAB",2720001227,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"CELLCEPT 500MG TAB",2720001228,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"BENICAR 20MG TAB",2720001231,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"BENICAR 20MG TAB",2720001232,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"OXCODONE 5MG IR CAP",2720001235,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"OXCODONE 5MG IR CAP",2720001236,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"THERAGESIC CREAM",2720001239,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"THERAGESIC CREAM",2720001240,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"NORCO 5MG/325MG TAB",2720001243,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NORCO 5MG/325MG TAB",2720001244,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROVIGIL 100MG TAB",2720001247,CDM,250,RC,,,Outpatient,,,93.71,46.855,,93.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",71.22,76,,56.98,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",70.28,75,,56.22,,,0,"percent of total billed charges","75% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",56.23,60,,44.98,,,0,"percent of total billed charges","60% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",42.17,45,,33.74,,,0,"percent of total billed charges","45% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.91,65,,48.73,,,0,"percent of total billed charges","65% of total billed charges",41.33,27,,33.06,,,0,"percent of total billed charges","27% of total billed charges",89.02,95,,71.22,,,0,"percent of total billed charges","95% of total billed charges",93.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",82.46,88,,65.97,,,0,"percent of total billed charges","88% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",41.33,93.71,
"PROVIGIL 100MG TAB",2720001248,CDM,250,RC,,,Outpatient,,,93.71,46.855,,93.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",71.22,76,,56.98,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",70.28,75,,56.22,,,0,"percent of total billed charges","75% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.47,72,,53.98,,,0,"percent of total billed charges","72% of total billed charges",56.23,60,,44.98,,,0,"percent of total billed charges","60% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",42.17,45,,33.74,,,0,"percent of total billed charges","45% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% CMS fee schedule",93.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.91,65,,48.73,,,0,"percent of total billed charges","65% of total billed charges",41.33,27,,33.06,,,0,"percent of total billed charges","27% of total billed charges",89.02,95,,71.22,,,0,"percent of total billed charges","95% of total billed charges",93.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",82.46,88,,65.97,,,0,"percent of total billed charges","88% of total billed charges",84.34,90,,67.47,,,0,"percent of total billed charges","90% of total billed charges",41.33,93.71,
"CALCIUM GLUCONATE 50",2720001251,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALCIUM GLUCONATE 50",2720001252,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"AMITIZA 24MCG CAP",2720001255,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"AMITIZA 24MCG CAP",2720001256,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"DEPAKOTE 125MG CAP",2720001259,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"DEPAKOTE 125MG CAP",2720001260,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"BYSTOLIC 5MG TAB",2720001263,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"BYSTOLIC 5MG TAB",2720001264,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"CLARITIN D12 TAB",2720001267,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CLARITIN D12 TAB",2720001268,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ALPHAGAN 0.1% 5ML OPHTH SOLN",2720001271,CDM,250,RC,,,Outpatient,,,368.24,184.12,,368.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",279.86,76,,223.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",276.18,75,,220.94,,,0,"percent of total billed charges","75% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",220.94,60,,176.75,,,0,"percent of total billed charges","60% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",165.71,45,,132.57,,,0,"percent of total billed charges","45% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",239.36,65,,191.49,,,0,"percent of total billed charges","65% of total billed charges",162.39,27,,129.91,,,0,"percent of total billed charges","27% of total billed charges",349.83,95,,279.86,,,0,"percent of total billed charges","95% of total billed charges",368.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",324.05,88,,259.24,,,0,"percent of total billed charges","88% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",162.39,368.24,
"ALPHAGAN 0.1% 5ML OPHTH SOLN",2720001272,CDM,250,RC,,,Outpatient,,,368.24,184.12,,368.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",279.86,76,,223.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",276.18,75,,220.94,,,0,"percent of total billed charges","75% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.13,72,,212.10,,,0,"percent of total billed charges","72% of total billed charges",220.94,60,,176.75,,,0,"percent of total billed charges","60% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",165.71,45,,132.57,,,0,"percent of total billed charges","45% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% CMS fee schedule",368.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",239.36,65,,191.49,,,0,"percent of total billed charges","65% of total billed charges",162.39,27,,129.91,,,0,"percent of total billed charges","27% of total billed charges",349.83,95,,279.86,,,0,"percent of total billed charges","95% of total billed charges",368.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",324.05,88,,259.24,,,0,"percent of total billed charges","88% of total billed charges",331.42,90,,265.14,,,0,"percent of total billed charges","90% of total billed charges",162.39,368.24,
"NEVANAC OPHTH SOLN",2720001275,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"NEVANAC OPHTH SOLN",2720001276,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"BACTROBAN 2% OINT",2720001279,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"BACTROBAN 2% OINT",2720001280,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"FIORINAL W/CODEINE TAB",2720001283,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"FIORINAL W/CODEINE TAB",2720001284,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PRADAXA 150MG CAP",2720001287,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"PRADAXA 150MG CAP",2720001288,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"ISOSORBIDE MONO 20MG TAB",2720001291,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ISOSORBIDE MONO 20MG TAB",2720001292,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"EXELON PATCH 4.6MG/24HR PATCH",2720001295,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"EXELON PATCH 4.6MG/24HR PATCH",2720001296,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"CYMBALTA 30 MG CAP",2720001299,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"CYMBALTA 30 MG CAP",2720001300,CDM,250,RC,,,Outpatient,,,28.67,14.335,,28.67,125,,,,,0,"fee schedule","125% of CMS fee schedule",21.79,76,,17.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",21.5,75,,17.20,,,0,"percent of total billed charges","75% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.64,72,,16.51,,,0,"percent of total billed charges","72% of total billed charges",17.2,60,,13.76,,,0,"percent of total billed charges","60% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.9,45,,10.32,,,0,"percent of total billed charges","45% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% CMS fee schedule",28.67,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.64,65,,14.91,,,0,"percent of total billed charges","65% of total billed charges",12.64,27,,10.11,,,0,"percent of total billed charges","27% of total billed charges",27.24,95,,21.79,,,0,"percent of total billed charges","95% of total billed charges",28.67,75,,,,,0,"fee schedule","75% of CMS fee schedule",25.23,88,,20.18,,,0,"percent of total billed charges","88% of total billed charges",25.8,90,,20.64,,,0,"percent of total billed charges","90% of total billed charges",12.64,28.67,
"NIX LICE TREATMENT 2",2720001303,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"NIX LICE TREATMENT 2",2720001304,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"FIECAINIDE 100MG TAB",2720001307,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"FIECAINIDE 100MG TAB",2720001308,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"COREG CR 10MG TAB",2720001311,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"COREG CR 10MG TAB",2720001312,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"ALFUZOSIN 10MG ER TAB",2720001315,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"ALFUZOSIN 10MG ER TAB",2720001316,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"VENTOLIN 90MCG INHALER",2720001319,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"VENTOLIN 90MCG INHALER",2720001320,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"KETOCANAZOLE 2% CR 15G",2720001323,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"KETOCANAZOLE 2% CR 15G",2720001324,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"FLUOCINODINE 0.05% CR 60G",2720001327,CDM,250,RC,,,Outpatient,,,126.79,63.395,,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,44.73,,,0,"percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.58,88,,89.26,,,0,"percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"FLUOCINODINE 0.05% CR 60G",2720001328,CDM,250,RC,,,Outpatient,,,126.79,63.395,,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,44.73,,,0,"percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.58,88,,89.26,,,0,"percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"ZITHROMAX 200MG/5ML SUSP UD",2720001331,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"ZITHROMAX 200MG/5ML SUSP UD",2720001332,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"CITIRIZINE 5MG/5ML LIQ UD",2720001335,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CITIRIZINE 5MG/5ML LIQ UD",2720001336,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LORATADINE 5 MG/5ML SYRUP UD",2720001339,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"LORATADINE 5 MG/5ML SYRUP UD",2720001340,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"BISOPROLOL 5 MG CAP",2720001343,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"BISOPROLOL 5 MG CAP",2720001344,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ELLA 30MG TAB",2720001347,CDM,250,RC,,,Outpatient,,,164.27,82.135,,164.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.85,76,,99.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",123.2,75,,98.56,,,0,"percent of total billed charges","75% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",98.56,60,,78.85,,,0,"percent of total billed charges","60% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",73.92,45,,59.14,,,0,"percent of total billed charges","45% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.78,65,,85.42,,,0,"percent of total billed charges","65% of total billed charges",72.44,27,,57.95,,,0,"percent of total billed charges","27% of total billed charges",156.06,95,,124.85,,,0,"percent of total billed charges","95% of total billed charges",164.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",144.56,88,,115.65,,,0,"percent of total billed charges","88% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",72.44,164.27,
"ELLA 30MG TAB",2720001348,CDM,250,RC,,,Outpatient,,,164.27,82.135,,164.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.85,76,,99.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",123.2,75,,98.56,,,0,"percent of total billed charges","75% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",98.56,60,,78.85,,,0,"percent of total billed charges","60% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",73.92,45,,59.14,,,0,"percent of total billed charges","45% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.78,65,,85.42,,,0,"percent of total billed charges","65% of total billed charges",72.44,27,,57.95,,,0,"percent of total billed charges","27% of total billed charges",156.06,95,,124.85,,,0,"percent of total billed charges","95% of total billed charges",164.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",144.56,88,,115.65,,,0,"percent of total billed charges","88% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",72.44,164.27,
"FLECAINIDE 50MG TAB",2720001351,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"FLECAINIDE 50MG TAB",2720001352,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"COREG CR 10 MG TAB",2720001355,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"COREG CR 10 MG TAB",2720001356,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"CARDEC DROPS 30 ML",2720001359,CDM,250,RC,,,Outpatient,,,83.79,41.895,,83.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",63.68,76,,50.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",62.84,75,,50.27,,,0,"percent of total billed charges","75% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",50.27,60,,40.22,,,0,"percent of total billed charges","60% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",37.71,45,,30.17,,,0,"percent of total billed charges","45% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.46,65,,43.57,,,0,"percent of total billed charges","65% of total billed charges",36.95,27,,29.56,,,0,"percent of total billed charges","27% of total billed charges",79.6,95,,63.68,,,0,"percent of total billed charges","95% of total billed charges",83.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",73.74,88,,58.99,,,0,"percent of total billed charges","88% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",36.95,83.79,
"CARDEC DROPS 30 ML",2720001360,CDM,250,RC,,,Outpatient,,,83.79,41.895,,83.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",63.68,76,,50.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",62.84,75,,50.27,,,0,"percent of total billed charges","75% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",50.27,60,,40.22,,,0,"percent of total billed charges","60% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",37.71,45,,30.17,,,0,"percent of total billed charges","45% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.46,65,,43.57,,,0,"percent of total billed charges","65% of total billed charges",36.95,27,,29.56,,,0,"percent of total billed charges","27% of total billed charges",79.6,95,,63.68,,,0,"percent of total billed charges","95% of total billed charges",83.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",73.74,88,,58.99,,,0,"percent of total billed charges","88% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",36.95,83.79,
"JTAN DPD DROPS 30 ML",2720001363,CDM,250,RC,,,Outpatient,,,265.7,132.85,,265.7,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.93,76,,161.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",191.3,72,,153.04,,,0,"percent of total billed charges","72% of total billed charges",199.28,75,,159.42,,,0,"percent of total billed charges","75% of total billed charges",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.3,72,,153.04,,,0,"percent of total billed charges","72% of total billed charges",159.42,60,,127.54,,,0,"percent of total billed charges","60% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",119.57,45,,95.66,,,0,"percent of total billed charges","45% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.7,100,,,,,0,"fee schedule","100% CMS fee schedule",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",172.71,65,,138.17,,,0,"percent of total billed charges","65% of total billed charges",117.17,27,,93.74,,,0,"percent of total billed charges","27% of total billed charges",252.42,95,,201.94,,,0,"percent of total billed charges","95% of total billed charges",265.7,75,,,,,0,"fee schedule","75% of CMS fee schedule",233.82,88,,187.06,,,0,"percent of total billed charges","88% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",117.17,265.7,
"JTAN DPD DROPS 30 ML",2720001364,CDM,250,RC,,,Outpatient,,,265.7,132.85,,265.7,125,,,,,0,"fee schedule","125% of CMS fee schedule",201.93,76,,161.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",191.3,72,,153.04,,,0,"percent of total billed charges","72% of total billed charges",199.28,75,,159.42,,,0,"percent of total billed charges","75% of total billed charges",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.3,72,,153.04,,,0,"percent of total billed charges","72% of total billed charges",159.42,60,,127.54,,,0,"percent of total billed charges","60% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",119.57,45,,95.66,,,0,"percent of total billed charges","45% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",265.7,100,,,,,0,"fee schedule","100% CMS fee schedule",265.7,100,,,,,0,"fee schedule","100% of CMS fee schedule",172.71,65,,138.17,,,0,"percent of total billed charges","65% of total billed charges",117.17,27,,93.74,,,0,"percent of total billed charges","27% of total billed charges",252.42,95,,201.94,,,0,"percent of total billed charges","95% of total billed charges",265.7,75,,,,,0,"fee schedule","75% of CMS fee schedule",233.82,88,,187.06,,,0,"percent of total billed charges","88% of total billed charges",239.13,90,,191.30,,,0,"percent of total billed charges","90% of total billed charges",117.17,265.7,
"TOBRADEX OINT 3.5G",2720001367,CDM,250,RC,,,Outpatient,,,198.45,99.225,,198.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",150.82,76,,120.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",148.84,75,,119.07,,,0,"percent of total billed charges","75% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",119.07,60,,95.26,,,0,"percent of total billed charges","60% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",89.3,45,,71.44,,,0,"percent of total billed charges","45% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,65,,103.19,,,0,"percent of total billed charges","65% of total billed charges",87.52,27,,70.02,,,0,"percent of total billed charges","27% of total billed charges",188.53,95,,150.82,,,0,"percent of total billed charges","95% of total billed charges",198.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",174.64,88,,139.71,,,0,"percent of total billed charges","88% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",87.52,198.45,
"TOBRADEX OINT 3.5G",2720001368,CDM,250,RC,,,Outpatient,,,198.45,99.225,,198.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",150.82,76,,120.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",148.84,75,,119.07,,,0,"percent of total billed charges","75% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.88,72,,114.30,,,0,"percent of total billed charges","72% of total billed charges",119.07,60,,95.26,,,0,"percent of total billed charges","60% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",89.3,45,,71.44,,,0,"percent of total billed charges","45% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% CMS fee schedule",198.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,65,,103.19,,,0,"percent of total billed charges","65% of total billed charges",87.52,27,,70.02,,,0,"percent of total billed charges","27% of total billed charges",188.53,95,,150.82,,,0,"percent of total billed charges","95% of total billed charges",198.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",174.64,88,,139.71,,,0,"percent of total billed charges","88% of total billed charges",178.61,90,,142.89,,,0,"percent of total billed charges","90% of total billed charges",87.52,198.45,
"KEFLEX 250/5 SUSP 100ML (S)",2720001371,CDM,250,RC,,,Outpatient,,,5030.71,2515.355,,5030.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",3823.34,76,,3058.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3622.11,72,,2897.69,,,0,"percent of total billed charges","72% of total billed charges",3773.03,75,,3018.42,,,0,"percent of total billed charges","75% of total billed charges",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",3622.11,72,,2897.69,,,0,"percent of total billed charges","72% of total billed charges",3018.43,60,,2414.74,,,0,"percent of total billed charges","60% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",2263.82,45,,1811.06,,,0,"percent of total billed charges","45% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",5030.71,100,,,,,0,"fee schedule","100% CMS fee schedule",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",3269.96,65,,2615.97,,,0,"percent of total billed charges","65% of total billed charges",2218.54,27,,1774.83,,,0,"percent of total billed charges","27% of total billed charges",4779.17,95,,3823.34,,,0,"percent of total billed charges","95% of total billed charges",5030.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",4427.02,88,,3541.62,,,0,"percent of total billed charges","88% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",2218.54,5030.71,
"KEFLEX 250/5 SUSP 100ML (S)",2720001372,CDM,250,RC,,,Outpatient,,,5030.71,2515.355,,5030.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",3823.34,76,,3058.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3622.11,72,,2897.69,,,0,"percent of total billed charges","72% of total billed charges",3773.03,75,,3018.42,,,0,"percent of total billed charges","75% of total billed charges",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",3622.11,72,,2897.69,,,0,"percent of total billed charges","72% of total billed charges",3018.43,60,,2414.74,,,0,"percent of total billed charges","60% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",2263.82,45,,1811.06,,,0,"percent of total billed charges","45% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",5030.71,100,,,,,0,"fee schedule","100% CMS fee schedule",5030.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",3269.96,65,,2615.97,,,0,"percent of total billed charges","65% of total billed charges",2218.54,27,,1774.83,,,0,"percent of total billed charges","27% of total billed charges",4779.17,95,,3823.34,,,0,"percent of total billed charges","95% of total billed charges",5030.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",4427.02,88,,3541.62,,,0,"percent of total billed charges","88% of total billed charges",4527.64,90,,3622.11,,,0,"percent of total billed charges","90% of total billed charges",2218.54,5030.71,
"KEFLEX 125/5 SUSP 100ML (S)",2720001375,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"KEFLEX 125/5 SUSP 100ML (S)",2720001376,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"ICHTHAMMOL 20% OINT 28 GM",2720001379,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ICHTHAMMOL 20% OINT 28 GM",2720001380,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"INPRATROPIUM NASAL SPRAY 15ML",2720001383,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"INPRATROPIUM NASAL SPRAY 15ML",2720001384,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"PERMETHRIN 5% CR 60G",2720001387,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PERMETHRIN 5% CR 60G",2720001388,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"LIDOCAINE 2% UROJECT 10 ML",2720001391,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"LIDOCAINE 2% UROJECT 10 ML",2720001392,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TAMIFLU 45 MG CAP",2720001395,CDM,250,RC,,,Outpatient,,,43,21.5,,43,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.68,76,,26.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",32.25,75,,25.80,,,0,"percent of total billed charges","75% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",25.8,60,,20.64,,,0,"percent of total billed charges","60% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",19.35,45,,15.48,,,0,"percent of total billed charges","45% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,100,,,,,0,"fee schedule","100% CMS fee schedule",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.95,65,,22.36,,,0,"percent of total billed charges","65% of total billed charges",18.96,27,,15.17,,,0,"percent of total billed charges","27% of total billed charges",40.85,95,,32.68,,,0,"percent of total billed charges","95% of total billed charges",43,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.84,88,,30.27,,,0,"percent of total billed charges","88% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",18.96,43,
"TAMIFLU 45 MG CAP",2720001396,CDM,250,RC,,,Outpatient,,,43,21.5,,43,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.68,76,,26.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",32.25,75,,25.80,,,0,"percent of total billed charges","75% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",25.8,60,,20.64,,,0,"percent of total billed charges","60% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",19.35,45,,15.48,,,0,"percent of total billed charges","45% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,100,,,,,0,"fee schedule","100% CMS fee schedule",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.95,65,,22.36,,,0,"percent of total billed charges","65% of total billed charges",18.96,27,,15.17,,,0,"percent of total billed charges","27% of total billed charges",40.85,95,,32.68,,,0,"percent of total billed charges","95% of total billed charges",43,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.84,88,,30.27,,,0,"percent of total billed charges","88% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",18.96,43,
"CRESTOR 40MG TAB",2720001399,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"CRESTOR 40MG TAB",2720001400,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"ONDANSTRON 1MG/ML LIQUID",2720001403,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"ONDANSTRON 1MG/ML LIQUID",2720001404,CDM,250,RC,,,Outpatient,,,19.85,9.925,,19.85,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.09,76,,12.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",14.89,75,,11.91,,,0,"percent of total billed charges","75% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.29,72,,11.43,,,0,"percent of total billed charges","72% of total billed charges",11.91,60,,9.53,,,0,"percent of total billed charges","60% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.93,45,,7.14,,,0,"percent of total billed charges","45% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% CMS fee schedule",19.85,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.9,65,,10.32,,,0,"percent of total billed charges","65% of total billed charges",8.75,27,,7.00,,,0,"percent of total billed charges","27% of total billed charges",18.86,95,,15.09,,,0,"percent of total billed charges","95% of total billed charges",19.85,75,,,,,0,"fee schedule","75% of CMS fee schedule",17.47,88,,13.98,,,0,"percent of total billed charges","88% of total billed charges",17.87,90,,14.30,,,0,"percent of total billed charges","90% of total billed charges",8.75,19.85,
"PYRAZINAMIDE 500MG TAB",2720001407,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"PYRAZINAMIDE 500MG TAB",2720001408,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"DAPSONE 100MG TAB",2720001411,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"DAPSONE 100MG TAB",2720001412,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"AUGMENTIN 200MG/5ML UD",2720001415,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"AUGMENTIN 200MG/5ML UD",2720001416,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ADVAIR HFA 45/21 INHALER",2720001419,CDM,250,RC,,,Outpatient,,,791.6,395.8,,791.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",601.62,76,,481.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",569.95,72,,455.96,,,0,"percent of total billed charges","72% of total billed charges",593.7,75,,474.96,,,0,"percent of total billed charges","75% of total billed charges",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",569.95,72,,455.96,,,0,"percent of total billed charges","72% of total billed charges",474.96,60,,379.97,,,0,"percent of total billed charges","60% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",356.22,45,,284.98,,,0,"percent of total billed charges","45% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",791.6,100,,,,,0,"fee schedule","100% CMS fee schedule",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",514.54,65,,411.63,,,0,"percent of total billed charges","65% of total billed charges",349.1,27,,279.28,,,0,"percent of total billed charges","27% of total billed charges",752.02,95,,601.62,,,0,"percent of total billed charges","95% of total billed charges",791.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",696.61,88,,557.29,,,0,"percent of total billed charges","88% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",349.1,791.6,
"ADVAIR HFA 45/21 INHALER",2720001420,CDM,250,RC,,,Outpatient,,,791.6,395.8,,791.6,125,,,,,0,"fee schedule","125% of CMS fee schedule",601.62,76,,481.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",569.95,72,,455.96,,,0,"percent of total billed charges","72% of total billed charges",593.7,75,,474.96,,,0,"percent of total billed charges","75% of total billed charges",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",569.95,72,,455.96,,,0,"percent of total billed charges","72% of total billed charges",474.96,60,,379.97,,,0,"percent of total billed charges","60% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",356.22,45,,284.98,,,0,"percent of total billed charges","45% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",791.6,100,,,,,0,"fee schedule","100% CMS fee schedule",791.6,100,,,,,0,"fee schedule","100% of CMS fee schedule",514.54,65,,411.63,,,0,"percent of total billed charges","65% of total billed charges",349.1,27,,279.28,,,0,"percent of total billed charges","27% of total billed charges",752.02,95,,601.62,,,0,"percent of total billed charges","95% of total billed charges",791.6,75,,,,,0,"fee schedule","75% of CMS fee schedule",696.61,88,,557.29,,,0,"percent of total billed charges","88% of total billed charges",712.44,90,,569.95,,,0,"percent of total billed charges","90% of total billed charges",349.1,791.6,
"NORCO 7.5/325MG TAB",2720001423,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"NORCO 7.5/325MG TAB",2720001424,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"ADVAIR HFA 115/21 INHALER",2720001427,CDM,250,RC,,,Outpatient,,,984.53,492.265,,984.53,125,,,,,0,"fee schedule","125% of CMS fee schedule",748.24,76,,598.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",708.86,72,,567.09,,,0,"percent of total billed charges","72% of total billed charges",738.4,75,,590.72,,,0,"percent of total billed charges","75% of total billed charges",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",708.86,72,,567.09,,,0,"percent of total billed charges","72% of total billed charges",590.72,60,,472.58,,,0,"percent of total billed charges","60% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",443.04,45,,354.43,,,0,"percent of total billed charges","45% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",984.53,100,,,,,0,"fee schedule","100% CMS fee schedule",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",639.94,65,,511.95,,,0,"percent of total billed charges","65% of total billed charges",434.18,27,,347.34,,,0,"percent of total billed charges","27% of total billed charges",935.3,95,,748.24,,,0,"percent of total billed charges","95% of total billed charges",984.53,75,,,,,0,"fee schedule","75% of CMS fee schedule",866.39,88,,693.11,,,0,"percent of total billed charges","88% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",434.18,984.53,
"ADVAIR HFA 115/21 INHALER",2720001428,CDM,250,RC,,,Outpatient,,,984.53,492.265,,984.53,125,,,,,0,"fee schedule","125% of CMS fee schedule",748.24,76,,598.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",708.86,72,,567.09,,,0,"percent of total billed charges","72% of total billed charges",738.4,75,,590.72,,,0,"percent of total billed charges","75% of total billed charges",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",708.86,72,,567.09,,,0,"percent of total billed charges","72% of total billed charges",590.72,60,,472.58,,,0,"percent of total billed charges","60% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",443.04,45,,354.43,,,0,"percent of total billed charges","45% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",984.53,100,,,,,0,"fee schedule","100% CMS fee schedule",984.53,100,,,,,0,"fee schedule","100% of CMS fee schedule",639.94,65,,511.95,,,0,"percent of total billed charges","65% of total billed charges",434.18,27,,347.34,,,0,"percent of total billed charges","27% of total billed charges",935.3,95,,748.24,,,0,"percent of total billed charges","95% of total billed charges",984.53,75,,,,,0,"fee schedule","75% of CMS fee schedule",866.39,88,,693.11,,,0,"percent of total billed charges","88% of total billed charges",886.08,90,,708.86,,,0,"percent of total billed charges","90% of total billed charges",434.18,984.53,
"ADVAIR HFA 230/21 INHALER",2720001431,CDM,250,RC,,,Outpatient,,,1358.28,679.14,,1358.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",1032.29,76,,825.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",977.96,72,,782.37,,,0,"percent of total billed charges","72% of total billed charges",1018.71,75,,814.97,,,0,"percent of total billed charges","75% of total billed charges",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",977.96,72,,782.37,,,0,"percent of total billed charges","72% of total billed charges",814.97,60,,651.98,,,0,"percent of total billed charges","60% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",611.23,45,,488.98,,,0,"percent of total billed charges","45% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",1358.28,100,,,,,0,"fee schedule","100% CMS fee schedule",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",882.88,65,,706.30,,,0,"percent of total billed charges","65% of total billed charges",599,27,,479.20,,,0,"percent of total billed charges","27% of total billed charges",1290.37,95,,1032.30,,,0,"percent of total billed charges","95% of total billed charges",1358.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",1195.29,88,,956.23,,,0,"percent of total billed charges","88% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",599,1358.28,
"ADVAIR HFA 230/21 INHALER",2720001432,CDM,250,RC,,,Outpatient,,,1358.28,679.14,,1358.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",1032.29,76,,825.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",977.96,72,,782.37,,,0,"percent of total billed charges","72% of total billed charges",1018.71,75,,814.97,,,0,"percent of total billed charges","75% of total billed charges",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",977.96,72,,782.37,,,0,"percent of total billed charges","72% of total billed charges",814.97,60,,651.98,,,0,"percent of total billed charges","60% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",611.23,45,,488.98,,,0,"percent of total billed charges","45% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",1358.28,100,,,,,0,"fee schedule","100% CMS fee schedule",1358.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",882.88,65,,706.30,,,0,"percent of total billed charges","65% of total billed charges",599,27,,479.20,,,0,"percent of total billed charges","27% of total billed charges",1290.37,95,,1032.30,,,0,"percent of total billed charges","95% of total billed charges",1358.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",1195.29,88,,956.23,,,0,"percent of total billed charges","88% of total billed charges",1222.45,90,,977.96,,,0,"percent of total billed charges","90% of total billed charges",599,1358.28,
"DOCUSATE SODIUM LIQ 100MG/10ML",2720001435,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DOCUSATE SODIUM LIQ 100MG/10ML",2720001436,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GLYCERIN SUPP ADULT",2720001439,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"GLYCERIN SUPP ADULT",2720001440,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"FLORISTOR 250MG CAP",2720001443,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"FLORISTOR 250MG CAP",2720001444,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NAC 600 MG CAP",2720001447,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"NAC 600 MG CAP",2720001448,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DOMEBORO PACKET",2720001451,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"DOMEBORO PACKET",2720001452,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"GEODON 20MG CAPSULE",2720001455,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"GEODON 20MG CAPSULE",2720001456,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"CEFDINIR 125MG/5 UD",2720001459,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"CEFDINIR 125MG/5 UD",2720001460,CDM,250,RC,,,Outpatient,,,16.54,8.27,,16.54,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.57,76,,10.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",12.41,75,,9.93,,,0,"percent of total billed charges","75% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.91,72,,9.53,,,0,"percent of total billed charges","72% of total billed charges",9.92,60,,7.94,,,0,"percent of total billed charges","60% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.44,45,,5.95,,,0,"percent of total billed charges","45% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% CMS fee schedule",16.54,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.75,65,,8.60,,,0,"percent of total billed charges","65% of total billed charges",7.29,27,,5.83,,,0,"percent of total billed charges","27% of total billed charges",15.71,95,,12.57,,,0,"percent of total billed charges","95% of total billed charges",16.54,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.56,88,,11.65,,,0,"percent of total billed charges","88% of total billed charges",14.89,90,,11.91,,,0,"percent of total billed charges","90% of total billed charges",7.29,16.54,
"CEFDINIR 250MG/5 UD",2720001463,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"CEFDINIR 250MG/5 UD",2720001464,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"CEFPROZIL 250MG/5 UD",2720001467,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"CEFPROZIL 250MG/5 UD",2720001468,CDM,250,RC,,,Outpatient,,,15.44,7.72,,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"CEPHALEXIN 125/5 UD",2720001471,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CEPHALEXIN 125/5 UD",2720001472,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"CEPHALEXIN 250/5 UD",2720001475,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"CEPHALEXIN 250/5 UD",2720001476,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"GABAPENTIN 600MG TAB",2720001479,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"GABAPENTIN 600MG TAB",2720001480,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"METHAZOLAMIDE 25MG TAB",2720001483,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"METHAZOLAMIDE 25MG TAB",2720001484,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"CALCIUM GLUCONATE 500MG TAB",2720001487,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"CALCIUM GLUCONATE 500MG TAB",2720001488,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"NEXT CHOICE 1.5MG TAB",2720001491,CDM,250,RC,,,Outpatient,,,201.76,100.88,,201.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",153.34,76,,122.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",145.27,72,,116.22,,,0,"percent of total billed charges","72% of total billed charges",151.32,75,,121.06,,,0,"percent of total billed charges","75% of total billed charges",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",145.27,72,,116.22,,,0,"percent of total billed charges","72% of total billed charges",121.06,60,,96.85,,,0,"percent of total billed charges","60% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",90.79,45,,72.63,,,0,"percent of total billed charges","45% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",201.76,100,,,,,0,"fee schedule","100% CMS fee schedule",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.14,65,,104.91,,,0,"percent of total billed charges","65% of total billed charges",88.98,27,,71.18,,,0,"percent of total billed charges","27% of total billed charges",191.67,95,,153.34,,,0,"percent of total billed charges","95% of total billed charges",201.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",177.55,88,,142.04,,,0,"percent of total billed charges","88% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",88.98,201.76,
"NEXT CHOICE 1.5MG TAB",2720001492,CDM,250,RC,,,Outpatient,,,201.76,100.88,,201.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",153.34,76,,122.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",145.27,72,,116.22,,,0,"percent of total billed charges","72% of total billed charges",151.32,75,,121.06,,,0,"percent of total billed charges","75% of total billed charges",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",145.27,72,,116.22,,,0,"percent of total billed charges","72% of total billed charges",121.06,60,,96.85,,,0,"percent of total billed charges","60% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",90.79,45,,72.63,,,0,"percent of total billed charges","45% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",201.76,100,,,,,0,"fee schedule","100% CMS fee schedule",201.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",131.14,65,,104.91,,,0,"percent of total billed charges","65% of total billed charges",88.98,27,,71.18,,,0,"percent of total billed charges","27% of total billed charges",191.67,95,,153.34,,,0,"percent of total billed charges","95% of total billed charges",201.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",177.55,88,,142.04,,,0,"percent of total billed charges","88% of total billed charges",181.58,90,,145.26,,,0,"percent of total billed charges","90% of total billed charges",88.98,201.76,
"BSS OPTH SOL 15ML",2720001495,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"BSS OPTH SOL 15ML",2720001496,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"EFFIENT 10 MG TAB",2720001499,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"EFFIENT 10 MG TAB",2720001500,CDM,250,RC,,,Outpatient,,,30.87,15.435,,30.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",23.46,76,,18.77,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",23.15,75,,18.52,,,0,"percent of total billed charges","75% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,72,,17.78,,,0,"percent of total billed charges","72% of total billed charges",18.52,60,,14.82,,,0,"percent of total billed charges","60% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.89,45,,11.11,,,0,"percent of total billed charges","45% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% CMS fee schedule",30.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.07,65,,16.06,,,0,"percent of total billed charges","65% of total billed charges",13.61,27,,10.89,,,0,"percent of total billed charges","27% of total billed charges",29.33,95,,23.46,,,0,"percent of total billed charges","95% of total billed charges",30.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",27.17,88,,21.74,,,0,"percent of total billed charges","88% of total billed charges",27.78,90,,22.22,,,0,"percent of total billed charges","90% of total billed charges",13.61,30.87,
"DALIRESP 500MG TAB",2720001503,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"DALIRESP 500MG TAB",2720001504,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"RANEXA 500MG TAB",2720001507,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"RANEXA 500MG TAB",2720001508,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"TAMIFLU 75MG CAP",2720001511,CDM,250,RC,,,Outpatient,,,65.05,32.525,,65.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",49.44,76,,39.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",48.79,75,,39.03,,,0,"percent of total billed charges","75% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",39.03,60,,31.22,,,0,"percent of total billed charges","60% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",29.27,45,,23.42,,,0,"percent of total billed charges","45% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,65,,33.82,,,0,"percent of total billed charges","65% of total billed charges",28.69,27,,22.95,,,0,"percent of total billed charges","27% of total billed charges",61.8,95,,49.44,,,0,"percent of total billed charges","95% of total billed charges",65.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",57.24,88,,45.79,,,0,"percent of total billed charges","88% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",28.69,65.05,
"TAMIFLU 75MG CAP",2720001512,CDM,250,RC,,,Outpatient,,,65.05,32.525,,65.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",49.44,76,,39.55,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",48.79,75,,39.03,,,0,"percent of total billed charges","75% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.84,72,,37.47,,,0,"percent of total billed charges","72% of total billed charges",39.03,60,,31.22,,,0,"percent of total billed charges","60% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",29.27,45,,23.42,,,0,"percent of total billed charges","45% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% CMS fee schedule",65.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.28,65,,33.82,,,0,"percent of total billed charges","65% of total billed charges",28.69,27,,22.95,,,0,"percent of total billed charges","27% of total billed charges",61.8,95,,49.44,,,0,"percent of total billed charges","95% of total billed charges",65.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",57.24,88,,45.79,,,0,"percent of total billed charges","88% of total billed charges",58.55,90,,46.84,,,0,"percent of total billed charges","90% of total billed charges",28.69,65.05,
"FLONASE INHALER",2720001515,CDM,250,RC,,,Outpatient,,,421.16,210.58,,421.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",320.08,76,,256.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",303.24,72,,242.59,,,0,"percent of total billed charges","72% of total billed charges",315.87,75,,252.70,,,0,"percent of total billed charges","75% of total billed charges",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",303.24,72,,242.59,,,0,"percent of total billed charges","72% of total billed charges",252.7,60,,202.16,,,0,"percent of total billed charges","60% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",189.52,45,,151.62,,,0,"percent of total billed charges","45% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",421.16,100,,,,,0,"fee schedule","100% CMS fee schedule",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",273.75,65,,219.00,,,0,"percent of total billed charges","65% of total billed charges",185.73,27,,148.58,,,0,"percent of total billed charges","27% of total billed charges",400.1,95,,320.08,,,0,"percent of total billed charges","95% of total billed charges",421.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",370.62,88,,296.50,,,0,"percent of total billed charges","88% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",185.73,421.16,
"FLONASE INHALER",2720001516,CDM,250,RC,,,Outpatient,,,421.16,210.58,,421.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",320.08,76,,256.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",303.24,72,,242.59,,,0,"percent of total billed charges","72% of total billed charges",315.87,75,,252.70,,,0,"percent of total billed charges","75% of total billed charges",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",303.24,72,,242.59,,,0,"percent of total billed charges","72% of total billed charges",252.7,60,,202.16,,,0,"percent of total billed charges","60% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",189.52,45,,151.62,,,0,"percent of total billed charges","45% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",421.16,100,,,,,0,"fee schedule","100% CMS fee schedule",421.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",273.75,65,,219.00,,,0,"percent of total billed charges","65% of total billed charges",185.73,27,,148.58,,,0,"percent of total billed charges","27% of total billed charges",400.1,95,,320.08,,,0,"percent of total billed charges","95% of total billed charges",421.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",370.62,88,,296.50,,,0,"percent of total billed charges","88% of total billed charges",379.04,90,,303.23,,,0,"percent of total billed charges","90% of total billed charges",185.73,421.16,
"NASONEX NASAL INHALER",2720001519,CDM,250,RC,,,Outpatient,,,577.71,288.855,,577.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",439.06,76,,351.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",415.95,72,,332.76,,,0,"percent of total billed charges","72% of total billed charges",433.28,75,,346.62,,,0,"percent of total billed charges","75% of total billed charges",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",415.95,72,,332.76,,,0,"percent of total billed charges","72% of total billed charges",346.63,60,,277.30,,,0,"percent of total billed charges","60% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",259.97,45,,207.98,,,0,"percent of total billed charges","45% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",577.71,100,,,,,0,"fee schedule","100% CMS fee schedule",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.51,65,,300.41,,,0,"percent of total billed charges","65% of total billed charges",254.77,27,,203.82,,,0,"percent of total billed charges","27% of total billed charges",548.82,95,,439.06,,,0,"percent of total billed charges","95% of total billed charges",577.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",508.38,88,,406.70,,,0,"percent of total billed charges","88% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",254.77,577.71,
"NASONEX NASAL INHALER",2720001520,CDM,250,RC,,,Outpatient,,,577.71,288.855,,577.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",439.06,76,,351.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",415.95,72,,332.76,,,0,"percent of total billed charges","72% of total billed charges",433.28,75,,346.62,,,0,"percent of total billed charges","75% of total billed charges",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",415.95,72,,332.76,,,0,"percent of total billed charges","72% of total billed charges",346.63,60,,277.30,,,0,"percent of total billed charges","60% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",259.97,45,,207.98,,,0,"percent of total billed charges","45% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",577.71,100,,,,,0,"fee schedule","100% CMS fee schedule",577.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.51,65,,300.41,,,0,"percent of total billed charges","65% of total billed charges",254.77,27,,203.82,,,0,"percent of total billed charges","27% of total billed charges",548.82,95,,439.06,,,0,"percent of total billed charges","95% of total billed charges",577.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",508.38,88,,406.70,,,0,"percent of total billed charges","88% of total billed charges",519.94,90,,415.95,,,0,"percent of total billed charges","90% of total billed charges",254.77,577.71,
"RESTORIL 7.5MG CAP",2720001523,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"RESTORIL 7.5MG CAP",2720001524,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"LORTAB 2.5/167/5ML SOLN UD",2720001531,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"LORTAB 2.5/167/5ML SOLN UD",2720001532,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"DIMETAPP 118ML",2720001587,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"DIMETAPP 118ML",2720001588,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"SODIUM BICARBONATE 4.2% (VIAL)",2720001814,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SODIUM BICARBONATE 4.2% (VIAL)",2720001815,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"MONSEL'S 8ML",2720001818,CDM,250,RC,,,Outpatient,,,33.39,16.695,,33.39,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.38,76,,20.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.04,72,,19.23,,,0,"percent of total billed charges","72% of total billed charges",25.04,75,,20.03,,,0,"percent of total billed charges","75% of total billed charges",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.04,72,,19.23,,,0,"percent of total billed charges","72% of total billed charges",20.03,60,,16.02,,,0,"percent of total billed charges","60% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",15.03,45,,12.02,,,0,"percent of total billed charges","45% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.39,100,,,,,0,"fee schedule","100% CMS fee schedule",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.7,65,,17.36,,,0,"percent of total billed charges","65% of total billed charges",14.72,27,,11.78,,,0,"percent of total billed charges","27% of total billed charges",31.72,95,,25.38,,,0,"percent of total billed charges","95% of total billed charges",33.39,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.38,88,,23.50,,,0,"percent of total billed charges","88% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",14.72,33.39,
"MONSEL'S 8ML",2720001819,CDM,250,RC,,,Outpatient,,,33.39,16.695,,33.39,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.38,76,,20.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.04,72,,19.23,,,0,"percent of total billed charges","72% of total billed charges",25.04,75,,20.03,,,0,"percent of total billed charges","75% of total billed charges",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.04,72,,19.23,,,0,"percent of total billed charges","72% of total billed charges",20.03,60,,16.02,,,0,"percent of total billed charges","60% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",15.03,45,,12.02,,,0,"percent of total billed charges","45% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.39,100,,,,,0,"fee schedule","100% CMS fee schedule",33.39,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.7,65,,17.36,,,0,"percent of total billed charges","65% of total billed charges",14.72,27,,11.78,,,0,"percent of total billed charges","27% of total billed charges",31.72,95,,25.38,,,0,"percent of total billed charges","95% of total billed charges",33.39,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.38,88,,23.50,,,0,"percent of total billed charges","88% of total billed charges",30.05,90,,24.04,,,0,"percent of total billed charges","90% of total billed charges",14.72,33.39,
"ESOMEPRAZOLE 40MG",2720001822,CDM,250,RC,,,Outpatient,,,23.04,11.52,,23.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.51,76,,14.01,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.59,72,,13.27,,,0,"percent of total billed charges","72% of total billed charges",17.28,75,,13.82,,,0,"percent of total billed charges","75% of total billed charges",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,72,,13.27,,,0,"percent of total billed charges","72% of total billed charges",13.82,60,,11.06,,,0,"percent of total billed charges","60% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",10.37,45,,8.30,,,0,"percent of total billed charges","45% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.04,100,,,,,0,"fee schedule","100% CMS fee schedule",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.98,65,,11.98,,,0,"percent of total billed charges","65% of total billed charges",10.16,27,,8.13,,,0,"percent of total billed charges","27% of total billed charges",21.89,95,,17.51,,,0,"percent of total billed charges","95% of total billed charges",23.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.28,88,,16.22,,,0,"percent of total billed charges","88% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",10.16,23.04,
"ESOMEPRAZOLE 40MG",2720001823,CDM,250,RC,,,Outpatient,,,23.04,11.52,,23.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.51,76,,14.01,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.59,72,,13.27,,,0,"percent of total billed charges","72% of total billed charges",17.28,75,,13.82,,,0,"percent of total billed charges","75% of total billed charges",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.59,72,,13.27,,,0,"percent of total billed charges","72% of total billed charges",13.82,60,,11.06,,,0,"percent of total billed charges","60% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",10.37,45,,8.30,,,0,"percent of total billed charges","45% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.04,100,,,,,0,"fee schedule","100% CMS fee schedule",23.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.98,65,,11.98,,,0,"percent of total billed charges","65% of total billed charges",10.16,27,,8.13,,,0,"percent of total billed charges","27% of total billed charges",21.89,95,,17.51,,,0,"percent of total billed charges","95% of total billed charges",23.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.28,88,,16.22,,,0,"percent of total billed charges","88% of total billed charges",20.74,90,,16.59,,,0,"percent of total billed charges","90% of total billed charges",10.16,23.04,
"COSOPT PF",2720001828,CDM,250,RC,,,Outpatient,,,12.75,6.375,,12.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.69,76,,7.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.18,72,,7.34,,,0,"percent of total billed charges","72% of total billed charges",9.56,75,,7.65,,,0,"percent of total billed charges","75% of total billed charges",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.18,72,,7.34,,,0,"percent of total billed charges","72% of total billed charges",7.65,60,,6.12,,,0,"percent of total billed charges","60% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",5.74,45,,4.59,,,0,"percent of total billed charges","45% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.75,100,,,,,0,"fee schedule","100% CMS fee schedule",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.29,65,,6.63,,,0,"percent of total billed charges","65% of total billed charges",5.62,27,,4.50,,,0,"percent of total billed charges","27% of total billed charges",12.11,95,,9.69,,,0,"percent of total billed charges","95% of total billed charges",12.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.22,88,,8.98,,,0,"percent of total billed charges","88% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",5.62,12.75,
"COSOPT PF",2720001829,CDM,250,RC,,,Outpatient,,,12.75,6.375,,12.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.69,76,,7.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.18,72,,7.34,,,0,"percent of total billed charges","72% of total billed charges",9.56,75,,7.65,,,0,"percent of total billed charges","75% of total billed charges",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.18,72,,7.34,,,0,"percent of total billed charges","72% of total billed charges",7.65,60,,6.12,,,0,"percent of total billed charges","60% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",5.74,45,,4.59,,,0,"percent of total billed charges","45% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.75,100,,,,,0,"fee schedule","100% CMS fee schedule",12.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.29,65,,6.63,,,0,"percent of total billed charges","65% of total billed charges",5.62,27,,4.50,,,0,"percent of total billed charges","27% of total billed charges",12.11,95,,9.69,,,0,"percent of total billed charges","95% of total billed charges",12.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.22,88,,8.98,,,0,"percent of total billed charges","88% of total billed charges",11.48,90,,9.18,,,0,"percent of total billed charges","90% of total billed charges",5.62,12.75,
"SPIRIVA 18MCG 5 CAPS",2720001832,CDM,250,RC,,,Outpatient,,,295.5,147.75,,295.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",224.58,76,,179.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",212.76,72,,170.21,,,0,"percent of total billed charges","72% of total billed charges",221.63,75,,177.30,,,0,"percent of total billed charges","75% of total billed charges",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.76,72,,170.21,,,0,"percent of total billed charges","72% of total billed charges",177.3,60,,141.84,,,0,"percent of total billed charges","60% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",132.98,45,,106.38,,,0,"percent of total billed charges","45% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",295.5,100,,,,,0,"fee schedule","100% CMS fee schedule",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.08,65,,153.66,,,0,"percent of total billed charges","65% of total billed charges",130.32,27,,104.26,,,0,"percent of total billed charges","27% of total billed charges",280.73,95,,224.58,,,0,"percent of total billed charges","95% of total billed charges",295.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",260.04,88,,208.03,,,0,"percent of total billed charges","88% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",130.32,295.5,
"SPIRIVA 18MCG 5 CAPS",2720001833,CDM,250,RC,,,Outpatient,,,295.5,147.75,,295.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",224.58,76,,179.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",212.76,72,,170.21,,,0,"percent of total billed charges","72% of total billed charges",221.63,75,,177.30,,,0,"percent of total billed charges","75% of total billed charges",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",212.76,72,,170.21,,,0,"percent of total billed charges","72% of total billed charges",177.3,60,,141.84,,,0,"percent of total billed charges","60% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",132.98,45,,106.38,,,0,"percent of total billed charges","45% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",295.5,100,,,,,0,"fee schedule","100% CMS fee schedule",295.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",192.08,65,,153.66,,,0,"percent of total billed charges","65% of total billed charges",130.32,27,,104.26,,,0,"percent of total billed charges","27% of total billed charges",280.73,95,,224.58,,,0,"percent of total billed charges","95% of total billed charges",295.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",260.04,88,,208.03,,,0,"percent of total billed charges","88% of total billed charges",265.95,90,,212.76,,,0,"percent of total billed charges","90% of total billed charges",130.32,295.5,
"VITAMIN D 5000 UNITS CAP",2720001836,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"VITAMIN D 5000 UNITS CAP",2720001837,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"VANCOMYCIN 125MG TAB",2720001840,CDM,250,RC,,,Outpatient,,,82.75,41.375,,82.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.89,76,,50.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.58,72,,47.66,,,0,"percent of total billed charges","72% of total billed charges",62.06,75,,49.65,,,0,"percent of total billed charges","75% of total billed charges",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.58,72,,47.66,,,0,"percent of total billed charges","72% of total billed charges",49.65,60,,39.72,,,0,"percent of total billed charges","60% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",37.24,45,,29.79,,,0,"percent of total billed charges","45% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.75,100,,,,,0,"fee schedule","100% CMS fee schedule",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.79,65,,43.03,,,0,"percent of total billed charges","65% of total billed charges",36.49,27,,29.19,,,0,"percent of total billed charges","27% of total billed charges",78.61,95,,62.89,,,0,"percent of total billed charges","95% of total billed charges",82.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.82,88,,58.26,,,0,"percent of total billed charges","88% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",36.49,82.75,
"VANCOMYCIN 125MG TAB",2720001841,CDM,250,RC,,,Outpatient,,,82.75,41.375,,82.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",62.89,76,,50.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",59.58,72,,47.66,,,0,"percent of total billed charges","72% of total billed charges",62.06,75,,49.65,,,0,"percent of total billed charges","75% of total billed charges",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.58,72,,47.66,,,0,"percent of total billed charges","72% of total billed charges",49.65,60,,39.72,,,0,"percent of total billed charges","60% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",37.24,45,,29.79,,,0,"percent of total billed charges","45% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.75,100,,,,,0,"fee schedule","100% CMS fee schedule",82.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.79,65,,43.03,,,0,"percent of total billed charges","65% of total billed charges",36.49,27,,29.19,,,0,"percent of total billed charges","27% of total billed charges",78.61,95,,62.89,,,0,"percent of total billed charges","95% of total billed charges",82.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",72.82,88,,58.26,,,0,"percent of total billed charges","88% of total billed charges",74.48,90,,59.58,,,0,"percent of total billed charges","90% of total billed charges",36.49,82.75,
"VANCOMYCIN 50MG/ML ORAL",2720001844,CDM,250,RC,,,Outpatient,,,26.24,13.12,,26.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.94,76,,15.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.89,72,,15.11,,,0,"percent of total billed charges","72% of total billed charges",19.68,75,,15.74,,,0,"percent of total billed charges","75% of total billed charges",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.89,72,,15.11,,,0,"percent of total billed charges","72% of total billed charges",15.74,60,,12.59,,,0,"percent of total billed charges","60% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",11.81,45,,9.45,,,0,"percent of total billed charges","45% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.24,100,,,,,0,"fee schedule","100% CMS fee schedule",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,65,,13.65,,,0,"percent of total billed charges","65% of total billed charges",11.57,27,,9.26,,,0,"percent of total billed charges","27% of total billed charges",24.93,95,,19.94,,,0,"percent of total billed charges","95% of total billed charges",26.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.09,88,,18.47,,,0,"percent of total billed charges","88% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",11.57,26.24,
"VANCOMYCIN 50MG/ML ORAL",2720001845,CDM,250,RC,,,Outpatient,,,26.24,13.12,,26.24,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.94,76,,15.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.89,72,,15.11,,,0,"percent of total billed charges","72% of total billed charges",19.68,75,,15.74,,,0,"percent of total billed charges","75% of total billed charges",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.89,72,,15.11,,,0,"percent of total billed charges","72% of total billed charges",15.74,60,,12.59,,,0,"percent of total billed charges","60% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",11.81,45,,9.45,,,0,"percent of total billed charges","45% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.24,100,,,,,0,"fee schedule","100% CMS fee schedule",26.24,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.06,65,,13.65,,,0,"percent of total billed charges","65% of total billed charges",11.57,27,,9.26,,,0,"percent of total billed charges","27% of total billed charges",24.93,95,,19.94,,,0,"percent of total billed charges","95% of total billed charges",26.24,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.09,88,,18.47,,,0,"percent of total billed charges","88% of total billed charges",23.62,90,,18.90,,,0,"percent of total billed charges","90% of total billed charges",11.57,26.24,
"BRIDION 100MG/ML",2720001848,CDM,250,RC,,,Outpatient,,,375.25,187.625,,375.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",285.19,76,,228.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",270.18,72,,216.14,,,0,"percent of total billed charges","72% of total billed charges",281.44,75,,225.15,,,0,"percent of total billed charges","75% of total billed charges",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",270.18,72,,216.14,,,0,"percent of total billed charges","72% of total billed charges",225.15,60,,180.12,,,0,"percent of total billed charges","60% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",168.86,45,,135.09,,,0,"percent of total billed charges","45% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.25,100,,,,,0,"fee schedule","100% CMS fee schedule",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",243.91,65,,195.13,,,0,"percent of total billed charges","65% of total billed charges",165.49,27,,132.39,,,0,"percent of total billed charges","27% of total billed charges",356.49,95,,285.19,,,0,"percent of total billed charges","95% of total billed charges",375.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",330.22,88,,264.18,,,0,"percent of total billed charges","88% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",165.49,375.25,
"BRIDION 100MG/ML",2720001849,CDM,250,RC,,,Outpatient,,,375.25,187.625,,375.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",285.19,76,,228.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",270.18,72,,216.14,,,0,"percent of total billed charges","72% of total billed charges",281.44,75,,225.15,,,0,"percent of total billed charges","75% of total billed charges",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",270.18,72,,216.14,,,0,"percent of total billed charges","72% of total billed charges",225.15,60,,180.12,,,0,"percent of total billed charges","60% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",168.86,45,,135.09,,,0,"percent of total billed charges","45% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",375.25,100,,,,,0,"fee schedule","100% CMS fee schedule",375.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",243.91,65,,195.13,,,0,"percent of total billed charges","65% of total billed charges",165.49,27,,132.39,,,0,"percent of total billed charges","27% of total billed charges",356.49,95,,285.19,,,0,"percent of total billed charges","95% of total billed charges",375.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",330.22,88,,264.18,,,0,"percent of total billed charges","88% of total billed charges",337.73,90,,270.18,,,0,"percent of total billed charges","90% of total billed charges",165.49,375.25,
"KEPPRA 500 MG 5ML",2720001852,CDM,250,RC,,,Outpatient,,,21.25,10.625,,21.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.15,76,,12.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.3,72,,12.24,,,0,"percent of total billed charges","72% of total billed charges",15.94,75,,12.75,,,0,"percent of total billed charges","75% of total billed charges",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,72,,12.24,,,0,"percent of total billed charges","72% of total billed charges",12.75,60,,10.20,,,0,"percent of total billed charges","60% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",9.56,45,,7.65,,,0,"percent of total billed charges","45% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.25,100,,,,,0,"fee schedule","100% CMS fee schedule",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.81,65,,11.05,,,0,"percent of total billed charges","65% of total billed charges",9.37,27,,7.50,,,0,"percent of total billed charges","27% of total billed charges",20.19,95,,16.15,,,0,"percent of total billed charges","95% of total billed charges",21.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.7,88,,14.96,,,0,"percent of total billed charges","88% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",9.37,21.25,
"KEPPRA 500 MG 5ML",2720001853,CDM,250,RC,,,Outpatient,,,21.25,10.625,,21.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.15,76,,12.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.3,72,,12.24,,,0,"percent of total billed charges","72% of total billed charges",15.94,75,,12.75,,,0,"percent of total billed charges","75% of total billed charges",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.3,72,,12.24,,,0,"percent of total billed charges","72% of total billed charges",12.75,60,,10.20,,,0,"percent of total billed charges","60% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",9.56,45,,7.65,,,0,"percent of total billed charges","45% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.25,100,,,,,0,"fee schedule","100% CMS fee schedule",21.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.81,65,,11.05,,,0,"percent of total billed charges","65% of total billed charges",9.37,27,,7.50,,,0,"percent of total billed charges","27% of total billed charges",20.19,95,,16.15,,,0,"percent of total billed charges","95% of total billed charges",21.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.7,88,,14.96,,,0,"percent of total billed charges","88% of total billed charges",19.13,90,,15.30,,,0,"percent of total billed charges","90% of total billed charges",9.37,21.25,
"BROMFED DM 5ML UD",2720001856,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"BROMFED DM 5ML UD",2720001857,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"MEPERIDINE HLC 50MG",2720001860,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"MEPERIDINE HLC 50MG",2720001861,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"CLONAZEPAM ODT 0.5MG TAB",2720001864,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"CLONAZEPAM ODT 0.5MG TAB",2720001865,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"EZ PAQUE 176GM",2720001868,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"EZ PAQUE 176GM",2720001869,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"TRANEXAMIC ACID 100MG/ML 10ML",2720001872,CDM,250,RC,,,Outpatient,,,121.5,60.75,,121.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",92.34,76,,73.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",87.48,72,,69.98,,,0,"percent of total billed charges","72% of total billed charges",91.13,75,,72.90,,,0,"percent of total billed charges","75% of total billed charges",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.48,72,,69.98,,,0,"percent of total billed charges","72% of total billed charges",72.9,60,,58.32,,,0,"percent of total billed charges","60% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",54.68,45,,43.74,,,0,"percent of total billed charges","45% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",121.5,100,,,,,0,"fee schedule","100% CMS fee schedule",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.98,65,,63.18,,,0,"percent of total billed charges","65% of total billed charges",53.58,27,,42.86,,,0,"percent of total billed charges","27% of total billed charges",115.43,95,,92.34,,,0,"percent of total billed charges","95% of total billed charges",121.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",106.92,88,,85.54,,,0,"percent of total billed charges","88% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",53.58,121.5,
"TRANEXAMIC ACID 100MG/ML 10ML",2720001873,CDM,250,RC,,,Outpatient,,,121.5,60.75,,121.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",92.34,76,,73.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",87.48,72,,69.98,,,0,"percent of total billed charges","72% of total billed charges",91.13,75,,72.90,,,0,"percent of total billed charges","75% of total billed charges",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.48,72,,69.98,,,0,"percent of total billed charges","72% of total billed charges",72.9,60,,58.32,,,0,"percent of total billed charges","60% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",54.68,45,,43.74,,,0,"percent of total billed charges","45% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",121.5,100,,,,,0,"fee schedule","100% CMS fee schedule",121.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.98,65,,63.18,,,0,"percent of total billed charges","65% of total billed charges",53.58,27,,42.86,,,0,"percent of total billed charges","27% of total billed charges",115.43,95,,92.34,,,0,"percent of total billed charges","95% of total billed charges",121.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",106.92,88,,85.54,,,0,"percent of total billed charges","88% of total billed charges",109.35,90,,87.48,,,0,"percent of total billed charges","90% of total billed charges",53.58,121.5,
"DEXAMETHASONE 10MG/1CC INJ",2720001876,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"DEXAMETHASONE 10MG/1CC INJ",2720001877,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SOTRADECOL 1% 20MG/2ML",2720001880,CDM,250,RC,,,Outpatient,,,308.75,154.375,,308.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",234.65,76,,187.72,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",222.3,72,,177.84,,,0,"percent of total billed charges","72% of total billed charges",231.56,75,,185.25,,,0,"percent of total billed charges","75% of total billed charges",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.3,72,,177.84,,,0,"percent of total billed charges","72% of total billed charges",185.25,60,,148.20,,,0,"percent of total billed charges","60% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",138.94,45,,111.15,,,0,"percent of total billed charges","45% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",308.75,100,,,,,0,"fee schedule","100% CMS fee schedule",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",200.69,65,,160.55,,,0,"percent of total billed charges","65% of total billed charges",136.16,27,,108.93,,,0,"percent of total billed charges","27% of total billed charges",293.31,95,,234.65,,,0,"percent of total billed charges","95% of total billed charges",308.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",271.7,88,,217.36,,,0,"percent of total billed charges","88% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",136.16,308.75,
"SOTRADECOL 1% 20MG/2ML",2720001881,CDM,250,RC,,,Outpatient,,,308.75,154.375,,308.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",234.65,76,,187.72,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",222.3,72,,177.84,,,0,"percent of total billed charges","72% of total billed charges",231.56,75,,185.25,,,0,"percent of total billed charges","75% of total billed charges",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.3,72,,177.84,,,0,"percent of total billed charges","72% of total billed charges",185.25,60,,148.20,,,0,"percent of total billed charges","60% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",138.94,45,,111.15,,,0,"percent of total billed charges","45% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",308.75,100,,,,,0,"fee schedule","100% CMS fee schedule",308.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",200.69,65,,160.55,,,0,"percent of total billed charges","65% of total billed charges",136.16,27,,108.93,,,0,"percent of total billed charges","27% of total billed charges",293.31,95,,234.65,,,0,"percent of total billed charges","95% of total billed charges",308.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",271.7,88,,217.36,,,0,"percent of total billed charges","88% of total billed charges",277.88,90,,222.30,,,0,"percent of total billed charges","90% of total billed charges",136.16,308.75,
"FLORASTORKIDS 250MG PWPK",2720001884,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"FLORASTORKIDS 250MG PWPK",2720001885,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"LIDOCAINE 4% CREA",2720001888,CDM,250,RC,,,Outpatient,,,45.12,22.56,,45.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.29,76,,27.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.49,72,,25.99,,,0,"percent of total billed charges","72% of total billed charges",33.84,75,,27.07,,,0,"percent of total billed charges","75% of total billed charges",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.49,72,,25.99,,,0,"percent of total billed charges","72% of total billed charges",27.07,60,,21.66,,,0,"percent of total billed charges","60% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",20.3,45,,16.24,,,0,"percent of total billed charges","45% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.12,100,,,,,0,"fee schedule","100% CMS fee schedule",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.33,65,,23.46,,,0,"percent of total billed charges","65% of total billed charges",19.9,27,,15.92,,,0,"percent of total billed charges","27% of total billed charges",42.86,95,,34.29,,,0,"percent of total billed charges","95% of total billed charges",45.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.71,88,,31.77,,,0,"percent of total billed charges","88% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",19.9,45.12,
"LIDOCAINE 4% CREA",2720001889,CDM,250,RC,,,Outpatient,,,45.12,22.56,,45.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.29,76,,27.43,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.49,72,,25.99,,,0,"percent of total billed charges","72% of total billed charges",33.84,75,,27.07,,,0,"percent of total billed charges","75% of total billed charges",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.49,72,,25.99,,,0,"percent of total billed charges","72% of total billed charges",27.07,60,,21.66,,,0,"percent of total billed charges","60% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",20.3,45,,16.24,,,0,"percent of total billed charges","45% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.12,100,,,,,0,"fee schedule","100% CMS fee schedule",45.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.33,65,,23.46,,,0,"percent of total billed charges","65% of total billed charges",19.9,27,,15.92,,,0,"percent of total billed charges","27% of total billed charges",42.86,95,,34.29,,,0,"percent of total billed charges","95% of total billed charges",45.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.71,88,,31.77,,,0,"percent of total billed charges","88% of total billed charges",40.61,90,,32.49,,,0,"percent of total billed charges","90% of total billed charges",19.9,45.12,
"METRONIDAZOLE 20MG/ML",2720001892,CDM,250,RC,,,Outpatient,,,11,5.5,,11,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.36,76,,6.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.92,72,,6.34,,,0,"percent of total billed charges","72% of total billed charges",8.25,75,,6.60,,,0,"percent of total billed charges","75% of total billed charges",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.92,72,,6.34,,,0,"percent of total billed charges","72% of total billed charges",6.6,60,,5.28,,,0,"percent of total billed charges","60% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",4.95,45,,3.96,,,0,"percent of total billed charges","45% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",11,100,,,,,0,"fee schedule","100% CMS fee schedule",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.15,65,,5.72,,,0,"percent of total billed charges","65% of total billed charges",4.85,27,,3.88,,,0,"percent of total billed charges","27% of total billed charges",10.45,95,,8.36,,,0,"percent of total billed charges","95% of total billed charges",11,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.68,88,,7.74,,,0,"percent of total billed charges","88% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",4.85,11,
"METRONIDAZOLE 20MG/ML",2720001893,CDM,250,RC,,,Outpatient,,,11,5.5,,11,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.36,76,,6.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.92,72,,6.34,,,0,"percent of total billed charges","72% of total billed charges",8.25,75,,6.60,,,0,"percent of total billed charges","75% of total billed charges",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.92,72,,6.34,,,0,"percent of total billed charges","72% of total billed charges",6.6,60,,5.28,,,0,"percent of total billed charges","60% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",4.95,45,,3.96,,,0,"percent of total billed charges","45% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",11,100,,,,,0,"fee schedule","100% CMS fee schedule",11,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.15,65,,5.72,,,0,"percent of total billed charges","65% of total billed charges",4.85,27,,3.88,,,0,"percent of total billed charges","27% of total billed charges",10.45,95,,8.36,,,0,"percent of total billed charges","95% of total billed charges",11,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.68,88,,7.74,,,0,"percent of total billed charges","88% of total billed charges",9.9,90,,7.92,,,0,"percent of total billed charges","90% of total billed charges",4.85,11,
"VANCOMYCIN 25MG/ML",2720001897,CDM,250,RC,,,Outpatient,,,311.5,155.75,,311.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",236.74,76,,189.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",224.28,72,,179.42,,,0,"percent of total billed charges","72% of total billed charges",233.63,75,,186.90,,,0,"percent of total billed charges","75% of total billed charges",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.28,72,,179.42,,,0,"percent of total billed charges","72% of total billed charges",186.9,60,,149.52,,,0,"percent of total billed charges","60% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",140.18,45,,112.14,,,0,"percent of total billed charges","45% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",311.5,100,,,,,0,"fee schedule","100% CMS fee schedule",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",202.48,65,,161.98,,,0,"percent of total billed charges","65% of total billed charges",137.37,27,,109.90,,,0,"percent of total billed charges","27% of total billed charges",295.93,95,,236.74,,,0,"percent of total billed charges","95% of total billed charges",311.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",274.12,88,,219.30,,,0,"percent of total billed charges","88% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",137.37,311.5,
"VANCOMYCIN 25MG/ML",2720001898,CDM,250,RC,,,Outpatient,,,311.5,155.75,,311.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",236.74,76,,189.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",224.28,72,,179.42,,,0,"percent of total billed charges","72% of total billed charges",233.63,75,,186.90,,,0,"percent of total billed charges","75% of total billed charges",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.28,72,,179.42,,,0,"percent of total billed charges","72% of total billed charges",186.9,60,,149.52,,,0,"percent of total billed charges","60% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",140.18,45,,112.14,,,0,"percent of total billed charges","45% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",311.5,100,,,,,0,"fee schedule","100% CMS fee schedule",311.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",202.48,65,,161.98,,,0,"percent of total billed charges","65% of total billed charges",137.37,27,,109.90,,,0,"percent of total billed charges","27% of total billed charges",295.93,95,,236.74,,,0,"percent of total billed charges","95% of total billed charges",311.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",274.12,88,,219.30,,,0,"percent of total billed charges","88% of total billed charges",280.35,90,,224.28,,,0,"percent of total billed charges","90% of total billed charges",137.37,311.5,
"LOTRISONE CR 45GM",2720001901,CDM,250,RC,,,Outpatient,,,127.25,63.625,,127.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.71,76,,77.37,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.62,72,,73.30,,,0,"percent of total billed charges","72% of total billed charges",95.44,75,,76.35,,,0,"percent of total billed charges","75% of total billed charges",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.62,72,,73.30,,,0,"percent of total billed charges","72% of total billed charges",76.35,60,,61.08,,,0,"percent of total billed charges","60% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",57.26,45,,45.81,,,0,"percent of total billed charges","45% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.25,100,,,,,0,"fee schedule","100% CMS fee schedule",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.71,65,,66.17,,,0,"percent of total billed charges","65% of total billed charges",56.12,27,,44.90,,,0,"percent of total billed charges","27% of total billed charges",120.89,95,,96.71,,,0,"percent of total billed charges","95% of total billed charges",127.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.98,88,,89.58,,,0,"percent of total billed charges","88% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",56.12,127.25,
"LOTRISONE CR 45GM",2720001902,CDM,250,RC,,,Outpatient,,,127.25,63.625,,127.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.71,76,,77.37,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.62,72,,73.30,,,0,"percent of total billed charges","72% of total billed charges",95.44,75,,76.35,,,0,"percent of total billed charges","75% of total billed charges",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.62,72,,73.30,,,0,"percent of total billed charges","72% of total billed charges",76.35,60,,61.08,,,0,"percent of total billed charges","60% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",57.26,45,,45.81,,,0,"percent of total billed charges","45% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",127.25,100,,,,,0,"fee schedule","100% CMS fee schedule",127.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",82.71,65,,66.17,,,0,"percent of total billed charges","65% of total billed charges",56.12,27,,44.90,,,0,"percent of total billed charges","27% of total billed charges",120.89,95,,96.71,,,0,"percent of total billed charges","95% of total billed charges",127.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",111.98,88,,89.58,,,0,"percent of total billed charges","88% of total billed charges",114.53,90,,91.62,,,0,"percent of total billed charges","90% of total billed charges",56.12,127.25,
"MISOPROSTOL 200MCG TAB",2720001905,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"MISOPROSTOL 200MCG TAB",2720001906,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"ROBITUSSIN AC SYRUP 10ML UD",2720001909,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"ROBITUSSIN AC SYRUP 10ML UD",2720001910,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"ELIQUIS 2.5MG TAB",2720001913,CDM,250,RC,,,Outpatient,,,23.75,11.875,,23.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.05,76,,14.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.1,72,,13.68,,,0,"percent of total billed charges","72% of total billed charges",17.81,75,,14.25,,,0,"percent of total billed charges","75% of total billed charges",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.1,72,,13.68,,,0,"percent of total billed charges","72% of total billed charges",14.25,60,,11.40,,,0,"percent of total billed charges","60% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",10.69,45,,8.55,,,0,"percent of total billed charges","45% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.75,100,,,,,0,"fee schedule","100% CMS fee schedule",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,65,,12.35,,,0,"percent of total billed charges","65% of total billed charges",10.47,27,,8.38,,,0,"percent of total billed charges","27% of total billed charges",22.56,95,,18.05,,,0,"percent of total billed charges","95% of total billed charges",23.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.9,88,,16.72,,,0,"percent of total billed charges","88% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",10.47,23.75,
"ELIQUIS 2.5MG TAB",2720001914,CDM,250,RC,,,Outpatient,,,23.75,11.875,,23.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.05,76,,14.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.1,72,,13.68,,,0,"percent of total billed charges","72% of total billed charges",17.81,75,,14.25,,,0,"percent of total billed charges","75% of total billed charges",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.1,72,,13.68,,,0,"percent of total billed charges","72% of total billed charges",14.25,60,,11.40,,,0,"percent of total billed charges","60% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",10.69,45,,8.55,,,0,"percent of total billed charges","45% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.75,100,,,,,0,"fee schedule","100% CMS fee schedule",23.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,65,,12.35,,,0,"percent of total billed charges","65% of total billed charges",10.47,27,,8.38,,,0,"percent of total billed charges","27% of total billed charges",22.56,95,,18.05,,,0,"percent of total billed charges","95% of total billed charges",23.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.9,88,,16.72,,,0,"percent of total billed charges","88% of total billed charges",21.38,90,,17.10,,,0,"percent of total billed charges","90% of total billed charges",10.47,23.75,
"LANOLIN CRM 7GM",2720001917,CDM,250,RC,,,Outpatient,,,10,5,,10,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.6,76,,6.08,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.2,72,,5.76,,,0,"percent of total billed charges","72% of total billed charges",7.5,75,,6.00,,,0,"percent of total billed charges","75% of total billed charges",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,72,,5.76,,,0,"percent of total billed charges","72% of total billed charges",6,60,,4.80,,,0,"percent of total billed charges","60% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",4.5,45,,3.60,,,0,"percent of total billed charges","45% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",10,100,,,,,0,"fee schedule","100% CMS fee schedule",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,65,,5.20,,,0,"percent of total billed charges","65% of total billed charges",4.41,27,,3.53,,,0,"percent of total billed charges","27% of total billed charges",9.5,95,,7.60,,,0,"percent of total billed charges","95% of total billed charges",10,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.8,88,,7.04,,,0,"percent of total billed charges","88% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",4.41,10,
"LANOLIN CRM 7GM",2720001918,CDM,250,RC,,,Outpatient,,,10,5,,10,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.6,76,,6.08,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.2,72,,5.76,,,0,"percent of total billed charges","72% of total billed charges",7.5,75,,6.00,,,0,"percent of total billed charges","75% of total billed charges",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.2,72,,5.76,,,0,"percent of total billed charges","72% of total billed charges",6,60,,4.80,,,0,"percent of total billed charges","60% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",4.5,45,,3.60,,,0,"percent of total billed charges","45% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",10,100,,,,,0,"fee schedule","100% CMS fee schedule",10,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,65,,5.20,,,0,"percent of total billed charges","65% of total billed charges",4.41,27,,3.53,,,0,"percent of total billed charges","27% of total billed charges",9.5,95,,7.60,,,0,"percent of total billed charges","95% of total billed charges",10,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.8,88,,7.04,,,0,"percent of total billed charges","88% of total billed charges",9,90,,7.20,,,0,"percent of total billed charges","90% of total billed charges",4.41,10,
"CAFFINE 200MG TAB",2720001921,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"CAFFINE 200MG TAB",2720001922,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"ENTRESTO 24MG / 26MG TAB",2720001925,CDM,250,RC,,,Outpatient,,,26.5,13.25,,26.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.14,76,,16.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.08,72,,15.26,,,0,"percent of total billed charges","72% of total billed charges",19.88,75,,15.90,,,0,"percent of total billed charges","75% of total billed charges",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.08,72,,15.26,,,0,"percent of total billed charges","72% of total billed charges",15.9,60,,12.72,,,0,"percent of total billed charges","60% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",11.93,45,,9.54,,,0,"percent of total billed charges","45% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.5,100,,,,,0,"fee schedule","100% CMS fee schedule",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,65,,13.78,,,0,"percent of total billed charges","65% of total billed charges",11.69,27,,9.35,,,0,"percent of total billed charges","27% of total billed charges",25.18,95,,20.14,,,0,"percent of total billed charges","95% of total billed charges",26.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.32,88,,18.66,,,0,"percent of total billed charges","88% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",11.69,26.5,
"ENTRESTO 24MG / 26MG TAB",2720001926,CDM,250,RC,,,Outpatient,,,26.5,13.25,,26.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.14,76,,16.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.08,72,,15.26,,,0,"percent of total billed charges","72% of total billed charges",19.88,75,,15.90,,,0,"percent of total billed charges","75% of total billed charges",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.08,72,,15.26,,,0,"percent of total billed charges","72% of total billed charges",15.9,60,,12.72,,,0,"percent of total billed charges","60% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",11.93,45,,9.54,,,0,"percent of total billed charges","45% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.5,100,,,,,0,"fee schedule","100% CMS fee schedule",26.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.23,65,,13.78,,,0,"percent of total billed charges","65% of total billed charges",11.69,27,,9.35,,,0,"percent of total billed charges","27% of total billed charges",25.18,95,,20.14,,,0,"percent of total billed charges","95% of total billed charges",26.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.32,88,,18.66,,,0,"percent of total billed charges","88% of total billed charges",23.85,90,,19.08,,,0,"percent of total billed charges","90% of total billed charges",11.69,26.5,
"MOUTH KOTE SPRAY 240ML",2720001929,CDM,250,RC,,,Outpatient,,,32.75,16.375,,32.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.89,76,,19.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.58,72,,18.86,,,0,"percent of total billed charges","72% of total billed charges",24.56,75,,19.65,,,0,"percent of total billed charges","75% of total billed charges",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.58,72,,18.86,,,0,"percent of total billed charges","72% of total billed charges",19.65,60,,15.72,,,0,"percent of total billed charges","60% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",14.74,45,,11.79,,,0,"percent of total billed charges","45% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.75,100,,,,,0,"fee schedule","100% CMS fee schedule",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,65,,17.03,,,0,"percent of total billed charges","65% of total billed charges",14.44,27,,11.55,,,0,"percent of total billed charges","27% of total billed charges",31.11,95,,24.89,,,0,"percent of total billed charges","95% of total billed charges",32.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.82,88,,23.06,,,0,"percent of total billed charges","88% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",14.44,32.75,
"MOUTH KOTE SPRAY 240ML",2720001930,CDM,250,RC,,,Outpatient,,,32.75,16.375,,32.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.89,76,,19.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.58,72,,18.86,,,0,"percent of total billed charges","72% of total billed charges",24.56,75,,19.65,,,0,"percent of total billed charges","75% of total billed charges",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.58,72,,18.86,,,0,"percent of total billed charges","72% of total billed charges",19.65,60,,15.72,,,0,"percent of total billed charges","60% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",14.74,45,,11.79,,,0,"percent of total billed charges","45% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.75,100,,,,,0,"fee schedule","100% CMS fee schedule",32.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.29,65,,17.03,,,0,"percent of total billed charges","65% of total billed charges",14.44,27,,11.55,,,0,"percent of total billed charges","27% of total billed charges",31.11,95,,24.89,,,0,"percent of total billed charges","95% of total billed charges",32.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.82,88,,23.06,,,0,"percent of total billed charges","88% of total billed charges",29.48,90,,23.58,,,0,"percent of total billed charges","90% of total billed charges",14.44,32.75,
"TRYPAN BLUE 0.06% OP",2720001933,CDM,250,RC,,,Outpatient,,,415.64,207.82,,415.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",315.89,76,,252.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",299.26,72,,239.41,,,0,"percent of total billed charges","72% of total billed charges",311.73,75,,249.38,,,0,"percent of total billed charges","75% of total billed charges",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",299.26,72,,239.41,,,0,"percent of total billed charges","72% of total billed charges",249.38,60,,199.50,,,0,"percent of total billed charges","60% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",187.04,45,,149.63,,,0,"percent of total billed charges","45% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",415.64,100,,,,,0,"fee schedule","100% CMS fee schedule",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",270.17,65,,216.14,,,0,"percent of total billed charges","65% of total billed charges",183.3,27,,146.64,,,0,"percent of total billed charges","27% of total billed charges",394.86,95,,315.89,,,0,"percent of total billed charges","95% of total billed charges",415.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",365.76,88,,292.61,,,0,"percent of total billed charges","88% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",183.3,415.64,
"TRYPAN BLUE 0.06% OP",2720001934,CDM,250,RC,,,Outpatient,,,415.64,207.82,,415.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",315.89,76,,252.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",299.26,72,,239.41,,,0,"percent of total billed charges","72% of total billed charges",311.73,75,,249.38,,,0,"percent of total billed charges","75% of total billed charges",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",299.26,72,,239.41,,,0,"percent of total billed charges","72% of total billed charges",249.38,60,,199.50,,,0,"percent of total billed charges","60% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",187.04,45,,149.63,,,0,"percent of total billed charges","45% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",415.64,100,,,,,0,"fee schedule","100% CMS fee schedule",415.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",270.17,65,,216.14,,,0,"percent of total billed charges","65% of total billed charges",183.3,27,,146.64,,,0,"percent of total billed charges","27% of total billed charges",394.86,95,,315.89,,,0,"percent of total billed charges","95% of total billed charges",415.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",365.76,88,,292.61,,,0,"percent of total billed charges","88% of total billed charges",374.08,90,,299.26,,,0,"percent of total billed charges","90% of total billed charges",183.3,415.64,
"CYANIDE ANTIDOTE KIT",2720001937,CDM,250,RC,,,Outpatient,,,2102.47,1051.235,,2102.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",1597.88,76,,1278.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1513.78,72,,1211.02,,,0,"percent of total billed charges","72% of total billed charges",1576.85,75,,1261.48,,,0,"percent of total billed charges","75% of total billed charges",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",1513.78,72,,1211.02,,,0,"percent of total billed charges","72% of total billed charges",1261.48,60,,1009.18,,,0,"percent of total billed charges","60% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",946.11,45,,756.89,,,0,"percent of total billed charges","45% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",2102.47,100,,,,,0,"fee schedule","100% CMS fee schedule",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",1366.61,65,,1093.29,,,0,"percent of total billed charges","65% of total billed charges",927.19,27,,741.75,,,0,"percent of total billed charges","27% of total billed charges",1997.35,95,,1597.88,,,0,"percent of total billed charges","95% of total billed charges",2102.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",1850.17,88,,1480.14,,,0,"percent of total billed charges","88% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",927.19,2102.47,
"CYANIDE ANTIDOTE KIT",2720001938,CDM,250,RC,,,Outpatient,,,2102.47,1051.235,,2102.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",1597.88,76,,1278.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1513.78,72,,1211.02,,,0,"percent of total billed charges","72% of total billed charges",1576.85,75,,1261.48,,,0,"percent of total billed charges","75% of total billed charges",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",1513.78,72,,1211.02,,,0,"percent of total billed charges","72% of total billed charges",1261.48,60,,1009.18,,,0,"percent of total billed charges","60% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",946.11,45,,756.89,,,0,"percent of total billed charges","45% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",2102.47,100,,,,,0,"fee schedule","100% CMS fee schedule",2102.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",1366.61,65,,1093.29,,,0,"percent of total billed charges","65% of total billed charges",927.19,27,,741.75,,,0,"percent of total billed charges","27% of total billed charges",1997.35,95,,1597.88,,,0,"percent of total billed charges","95% of total billed charges",2102.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",1850.17,88,,1480.14,,,0,"percent of total billed charges","88% of total billed charges",1892.22,90,,1513.78,,,0,"percent of total billed charges","90% of total billed charges",927.19,2102.47,
"DIASTAT 5MG GEL",2720001941,CDM,250,RC,,,Outpatient,,,1195.11,597.555,,1195.11,125,,,,,0,"fee schedule","125% of CMS fee schedule",908.28,76,,726.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",860.48,72,,688.38,,,0,"percent of total billed charges","72% of total billed charges",896.33,75,,717.06,,,0,"percent of total billed charges","75% of total billed charges",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",860.48,72,,688.38,,,0,"percent of total billed charges","72% of total billed charges",717.07,60,,573.66,,,0,"percent of total billed charges","60% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",537.8,45,,430.24,,,0,"percent of total billed charges","45% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",1195.11,100,,,,,0,"fee schedule","100% CMS fee schedule",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",776.82,65,,621.46,,,0,"percent of total billed charges","65% of total billed charges",527.04,27,,421.63,,,0,"percent of total billed charges","27% of total billed charges",1135.35,95,,908.28,,,0,"percent of total billed charges","95% of total billed charges",1195.11,75,,,,,0,"fee schedule","75% of CMS fee schedule",1051.7,88,,841.36,,,0,"percent of total billed charges","88% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",527.04,1195.11,
"DIASTAT 5MG GEL",2720001942,CDM,250,RC,,,Outpatient,,,1195.11,597.555,,1195.11,125,,,,,0,"fee schedule","125% of CMS fee schedule",908.28,76,,726.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",860.48,72,,688.38,,,0,"percent of total billed charges","72% of total billed charges",896.33,75,,717.06,,,0,"percent of total billed charges","75% of total billed charges",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",860.48,72,,688.38,,,0,"percent of total billed charges","72% of total billed charges",717.07,60,,573.66,,,0,"percent of total billed charges","60% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",537.8,45,,430.24,,,0,"percent of total billed charges","45% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",1195.11,100,,,,,0,"fee schedule","100% CMS fee schedule",1195.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",776.82,65,,621.46,,,0,"percent of total billed charges","65% of total billed charges",527.04,27,,421.63,,,0,"percent of total billed charges","27% of total billed charges",1135.35,95,,908.28,,,0,"percent of total billed charges","95% of total billed charges",1195.11,75,,,,,0,"fee schedule","75% of CMS fee schedule",1051.7,88,,841.36,,,0,"percent of total billed charges","88% of total billed charges",1075.6,90,,860.48,,,0,"percent of total billed charges","90% of total billed charges",527.04,1195.11,
"FLOVENT 220MG INHALE",2720001945,CDM,250,RC,,,Outpatient,,,1211.65,605.825,,1211.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",920.85,76,,736.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",872.39,72,,697.91,,,0,"percent of total billed charges","72% of total billed charges",908.74,75,,726.99,,,0,"percent of total billed charges","75% of total billed charges",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",872.39,72,,697.91,,,0,"percent of total billed charges","72% of total billed charges",726.99,60,,581.59,,,0,"percent of total billed charges","60% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",545.24,45,,436.19,,,0,"percent of total billed charges","45% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",1211.65,100,,,,,0,"fee schedule","100% CMS fee schedule",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",787.57,65,,630.06,,,0,"percent of total billed charges","65% of total billed charges",534.34,27,,427.47,,,0,"percent of total billed charges","27% of total billed charges",1151.07,95,,920.86,,,0,"percent of total billed charges","95% of total billed charges",1211.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",1066.25,88,,853.00,,,0,"percent of total billed charges","88% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",534.34,1211.65,
"FLOVENT 220MG INHALE",2720001946,CDM,250,RC,,,Outpatient,,,1211.65,605.825,,1211.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",920.85,76,,736.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",872.39,72,,697.91,,,0,"percent of total billed charges","72% of total billed charges",908.74,75,,726.99,,,0,"percent of total billed charges","75% of total billed charges",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",872.39,72,,697.91,,,0,"percent of total billed charges","72% of total billed charges",726.99,60,,581.59,,,0,"percent of total billed charges","60% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",545.24,45,,436.19,,,0,"percent of total billed charges","45% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",1211.65,100,,,,,0,"fee schedule","100% CMS fee schedule",1211.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",787.57,65,,630.06,,,0,"percent of total billed charges","65% of total billed charges",534.34,27,,427.47,,,0,"percent of total billed charges","27% of total billed charges",1151.07,95,,920.86,,,0,"percent of total billed charges","95% of total billed charges",1211.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",1066.25,88,,853.00,,,0,"percent of total billed charges","88% of total billed charges",1090.49,90,,872.39,,,0,"percent of total billed charges","90% of total billed charges",534.34,1211.65,
"PROSTIN VR PEDI",2720001949,CDM,250,RC,,,Outpatient,,,222.71,111.355,,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,135.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,133.62,,,0,"percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,78.58,,,0,"percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,156.78,,,0,"percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"PROSTIN VR PEDI",2720001950,CDM,250,RC,,,Outpatient,,,222.71,111.355,,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,135.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,133.62,,,0,"percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,78.58,,,0,"percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,156.78,,,0,"percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"LOVENOX 100MG INJ",2720001957,CDM,636,RC,J1650,HCPCS,Outpatient,,,454.23,227.115,U8,454.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",345.21,76,,22.07,22.07,22.07,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.95,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.95,350,,,,,0,"fee schedule","350% of BCBS fee schedule",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.95,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.27,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",204.4,45,,163.52,,,0,"percent of total billed charges","45% of total billed charges",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",454.23,100,,,,,0,"fee schedule","100% CMS fee schedule",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",295.25,65,,236.20,,,0,"percent of total billed charges","65% of total billed charges",200.32,27,,2.89,2.29,5.31,"1 through 10","percent of total billed charges","27% of total billed charges",431.52,95,,345.22,,,0,"percent of total billed charges","95% of total billed charges",454.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",399.72,88,,319.78,,,0,"percent of total billed charges","88% of total billed charges",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",0.27,454.23,
"LOVENOX 100MG INJ",2720001958,CDM,636,RC,J1650,HCPCS,Outpatient,,,454.23,227.115,U8,454.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",345.21,76,,22.07,22.07,22.07,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.95,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.95,350,,,,,0,"fee schedule","350% of BCBS fee schedule",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.95,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.27,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",204.4,45,,163.52,,,0,"percent of total billed charges","45% of total billed charges",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",454.23,100,,,,,0,"fee schedule","100% CMS fee schedule",454.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",295.25,65,,236.20,,,0,"percent of total billed charges","65% of total billed charges",200.32,27,,2.89,2.29,5.31,"1 through 10","percent of total billed charges","27% of total billed charges",431.52,95,,345.22,,,0,"percent of total billed charges","95% of total billed charges",454.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",399.72,88,,319.78,,,0,"percent of total billed charges","88% of total billed charges",408.81,90,,327.05,,,0,"percent of total billed charges","90% of total billed charges",0.27,454.23,
"ADVAIR DISKUS INHALE",2720001961,CDM,250,RC,,,Outpatient,,,764.03,382.015,,764.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",580.66,76,,464.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",550.1,72,,440.08,,,0,"percent of total billed charges","72% of total billed charges",573.02,75,,458.42,,,0,"percent of total billed charges","75% of total billed charges",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",550.1,72,,440.08,,,0,"percent of total billed charges","72% of total billed charges",458.42,60,,366.74,,,0,"percent of total billed charges","60% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",343.81,45,,275.05,,,0,"percent of total billed charges","45% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",764.03,100,,,,,0,"fee schedule","100% CMS fee schedule",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",496.62,65,,397.30,,,0,"percent of total billed charges","65% of total billed charges",336.94,27,,269.55,,,0,"percent of total billed charges","27% of total billed charges",725.83,95,,580.66,,,0,"percent of total billed charges","95% of total billed charges",764.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",672.35,88,,537.88,,,0,"percent of total billed charges","88% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",336.94,764.03,
"ADVAIR DISKUS INHALE",2720001962,CDM,250,RC,,,Outpatient,,,764.03,382.015,,764.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",580.66,76,,464.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",550.1,72,,440.08,,,0,"percent of total billed charges","72% of total billed charges",573.02,75,,458.42,,,0,"percent of total billed charges","75% of total billed charges",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",550.1,72,,440.08,,,0,"percent of total billed charges","72% of total billed charges",458.42,60,,366.74,,,0,"percent of total billed charges","60% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",343.81,45,,275.05,,,0,"percent of total billed charges","45% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",764.03,100,,,,,0,"fee schedule","100% CMS fee schedule",764.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",496.62,65,,397.30,,,0,"percent of total billed charges","65% of total billed charges",336.94,27,,269.55,,,0,"percent of total billed charges","27% of total billed charges",725.83,95,,580.66,,,0,"percent of total billed charges","95% of total billed charges",764.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",672.35,88,,537.88,,,0,"percent of total billed charges","88% of total billed charges",687.63,90,,550.10,,,0,"percent of total billed charges","90% of total billed charges",336.94,764.03,
"PROSTIN E2 SUPP",2720001965,CDM,250,RC,,,Outpatient,,,5146.47,2573.235,,5146.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",3911.32,76,,3129.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3705.46,72,,2964.37,,,0,"percent of total billed charges","72% of total billed charges",3859.85,75,,3087.88,,,0,"percent of total billed charges","75% of total billed charges",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",3705.46,72,,2964.37,,,0,"percent of total billed charges","72% of total billed charges",3087.88,60,,2470.30,,,0,"percent of total billed charges","60% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",2315.91,45,,1852.73,,,0,"percent of total billed charges","45% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5146.47,100,,,,,0,"fee schedule","100% CMS fee schedule",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",3345.21,65,,2676.17,,,0,"percent of total billed charges","65% of total billed charges",2269.59,27,,1815.67,,,0,"percent of total billed charges","27% of total billed charges",4889.15,95,,3911.32,,,0,"percent of total billed charges","95% of total billed charges",5146.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",4528.89,88,,3623.11,,,0,"percent of total billed charges","88% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",2269.59,5146.47,
"PROSTIN E2 SUPP",2720001966,CDM,250,RC,,,Outpatient,,,5146.47,2573.235,,5146.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",3911.32,76,,3129.06,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3705.46,72,,2964.37,,,0,"percent of total billed charges","72% of total billed charges",3859.85,75,,3087.88,,,0,"percent of total billed charges","75% of total billed charges",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",3705.46,72,,2964.37,,,0,"percent of total billed charges","72% of total billed charges",3087.88,60,,2470.30,,,0,"percent of total billed charges","60% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",2315.91,45,,1852.73,,,0,"percent of total billed charges","45% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",5146.47,100,,,,,0,"fee schedule","100% CMS fee schedule",5146.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",3345.21,65,,2676.17,,,0,"percent of total billed charges","65% of total billed charges",2269.59,27,,1815.67,,,0,"percent of total billed charges","27% of total billed charges",4889.15,95,,3911.32,,,0,"percent of total billed charges","95% of total billed charges",5146.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",4528.89,88,,3623.11,,,0,"percent of total billed charges","88% of total billed charges",4631.82,90,,3705.46,,,0,"percent of total billed charges","90% of total billed charges",2269.59,5146.47,
"ALBUMIN 25% 100ML/VI",2720001969,CDM,250,RC,,,Outpatient,,,1119.04,559.52,,1119.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",850.47,76,,680.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",805.71,72,,644.57,,,0,"percent of total billed charges","72% of total billed charges",839.28,75,,671.42,,,0,"percent of total billed charges","75% of total billed charges",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",805.71,72,,644.57,,,0,"percent of total billed charges","72% of total billed charges",671.42,60,,537.14,,,0,"percent of total billed charges","60% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",503.57,45,,402.86,,,0,"percent of total billed charges","45% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",1119.04,100,,,,,0,"fee schedule","100% CMS fee schedule",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",727.38,65,,581.90,,,0,"percent of total billed charges","65% of total billed charges",493.5,27,,394.80,,,0,"percent of total billed charges","27% of total billed charges",1063.09,95,,850.47,,,0,"percent of total billed charges","95% of total billed charges",1119.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",984.76,88,,787.81,,,0,"percent of total billed charges","88% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",493.5,1119.04,
"ALBUMIN 25% 100ML/VI",2720001970,CDM,250,RC,,,Outpatient,,,1119.04,559.52,,1119.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",850.47,76,,680.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",805.71,72,,644.57,,,0,"percent of total billed charges","72% of total billed charges",839.28,75,,671.42,,,0,"percent of total billed charges","75% of total billed charges",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",805.71,72,,644.57,,,0,"percent of total billed charges","72% of total billed charges",671.42,60,,537.14,,,0,"percent of total billed charges","60% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",503.57,45,,402.86,,,0,"percent of total billed charges","45% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",1119.04,100,,,,,0,"fee schedule","100% CMS fee schedule",1119.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",727.38,65,,581.90,,,0,"percent of total billed charges","65% of total billed charges",493.5,27,,394.80,,,0,"percent of total billed charges","27% of total billed charges",1063.09,95,,850.47,,,0,"percent of total billed charges","95% of total billed charges",1119.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",984.76,88,,787.81,,,0,"percent of total billed charges","88% of total billed charges",1007.14,90,,805.71,,,0,"percent of total billed charges","90% of total billed charges",493.5,1119.04,
"CERVIDIL 10MG/SUPP",2720001973,CDM,250,RC,,,Outpatient,,,979.02,489.51,,979.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",744.06,76,,595.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",704.89,72,,563.91,,,0,"percent of total billed charges","72% of total billed charges",734.27,75,,587.42,,,0,"percent of total billed charges","75% of total billed charges",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",704.89,72,,563.91,,,0,"percent of total billed charges","72% of total billed charges",587.41,60,,469.93,,,0,"percent of total billed charges","60% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",440.56,45,,352.45,,,0,"percent of total billed charges","45% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",979.02,100,,,,,0,"fee schedule","100% CMS fee schedule",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",636.36,65,,509.09,,,0,"percent of total billed charges","65% of total billed charges",431.75,27,,345.40,,,0,"percent of total billed charges","27% of total billed charges",930.07,95,,744.06,,,0,"percent of total billed charges","95% of total billed charges",979.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",861.54,88,,689.23,,,0,"percent of total billed charges","88% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",431.75,979.02,
"CERVIDIL 10MG/SUPP",2720001974,CDM,250,RC,,,Outpatient,,,979.02,489.51,,979.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",744.06,76,,595.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",704.89,72,,563.91,,,0,"percent of total billed charges","72% of total billed charges",734.27,75,,587.42,,,0,"percent of total billed charges","75% of total billed charges",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",704.89,72,,563.91,,,0,"percent of total billed charges","72% of total billed charges",587.41,60,,469.93,,,0,"percent of total billed charges","60% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",440.56,45,,352.45,,,0,"percent of total billed charges","45% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",979.02,100,,,,,0,"fee schedule","100% CMS fee schedule",979.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",636.36,65,,509.09,,,0,"percent of total billed charges","65% of total billed charges",431.75,27,,345.40,,,0,"percent of total billed charges","27% of total billed charges",930.07,95,,744.06,,,0,"percent of total billed charges","95% of total billed charges",979.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",861.54,88,,689.23,,,0,"percent of total billed charges","88% of total billed charges",881.12,90,,704.90,,,0,"percent of total billed charges","90% of total billed charges",431.75,979.02,
"MIACALCIN SPRAY",2720001977,CDM,250,RC,,,Outpatient,,,655.99,327.995,,655.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",498.55,76,,398.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",472.31,72,,377.85,,,0,"percent of total billed charges","72% of total billed charges",491.99,75,,393.59,,,0,"percent of total billed charges","75% of total billed charges",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",472.31,72,,377.85,,,0,"percent of total billed charges","72% of total billed charges",393.59,60,,314.87,,,0,"percent of total billed charges","60% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",295.2,45,,236.16,,,0,"percent of total billed charges","45% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",655.99,100,,,,,0,"fee schedule","100% CMS fee schedule",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",426.39,65,,341.11,,,0,"percent of total billed charges","65% of total billed charges",289.29,27,,231.43,,,0,"percent of total billed charges","27% of total billed charges",623.19,95,,498.55,,,0,"percent of total billed charges","95% of total billed charges",655.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",577.27,88,,461.82,,,0,"percent of total billed charges","88% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",289.29,655.99,
"MIACALCIN SPRAY",2720001978,CDM,250,RC,,,Outpatient,,,655.99,327.995,,655.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",498.55,76,,398.84,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",472.31,72,,377.85,,,0,"percent of total billed charges","72% of total billed charges",491.99,75,,393.59,,,0,"percent of total billed charges","75% of total billed charges",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",472.31,72,,377.85,,,0,"percent of total billed charges","72% of total billed charges",393.59,60,,314.87,,,0,"percent of total billed charges","60% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",295.2,45,,236.16,,,0,"percent of total billed charges","45% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",655.99,100,,,,,0,"fee schedule","100% CMS fee schedule",655.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",426.39,65,,341.11,,,0,"percent of total billed charges","65% of total billed charges",289.29,27,,231.43,,,0,"percent of total billed charges","27% of total billed charges",623.19,95,,498.55,,,0,"percent of total billed charges","95% of total billed charges",655.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",577.27,88,,461.82,,,0,"percent of total billed charges","88% of total billed charges",590.39,90,,472.31,,,0,"percent of total billed charges","90% of total billed charges",289.29,655.99,
VISCOAT,2720001981,CDM,250,RC,,,Outpatient,,,691.27,345.635,,691.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",525.37,76,,420.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",497.71,72,,398.17,,,0,"percent of total billed charges","72% of total billed charges",518.45,75,,414.76,,,0,"percent of total billed charges","75% of total billed charges",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",497.71,72,,398.17,,,0,"percent of total billed charges","72% of total billed charges",414.76,60,,331.81,,,0,"percent of total billed charges","60% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",311.07,45,,248.86,,,0,"percent of total billed charges","45% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",691.27,100,,,,,0,"fee schedule","100% CMS fee schedule",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.33,65,,359.46,,,0,"percent of total billed charges","65% of total billed charges",304.85,27,,243.88,,,0,"percent of total billed charges","27% of total billed charges",656.71,95,,525.37,,,0,"percent of total billed charges","95% of total billed charges",691.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",608.32,88,,486.66,,,0,"percent of total billed charges","88% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",304.85,691.27,
VISCOAT,2720001982,CDM,250,RC,,,Outpatient,,,691.27,345.635,,691.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",525.37,76,,420.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",497.71,72,,398.17,,,0,"percent of total billed charges","72% of total billed charges",518.45,75,,414.76,,,0,"percent of total billed charges","75% of total billed charges",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",497.71,72,,398.17,,,0,"percent of total billed charges","72% of total billed charges",414.76,60,,331.81,,,0,"percent of total billed charges","60% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",311.07,45,,248.86,,,0,"percent of total billed charges","45% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",691.27,100,,,,,0,"fee schedule","100% CMS fee schedule",691.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",449.33,65,,359.46,,,0,"percent of total billed charges","65% of total billed charges",304.85,27,,243.88,,,0,"percent of total billed charges","27% of total billed charges",656.71,95,,525.37,,,0,"percent of total billed charges","95% of total billed charges",691.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",608.32,88,,486.66,,,0,"percent of total billed charges","88% of total billed charges",622.14,90,,497.71,,,0,"percent of total billed charges","90% of total billed charges",304.85,691.27,
"ADVAIR DISKUS 100/50",2720001985,CDM,250,RC,,,Outpatient,,,468.56,234.28,,468.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",356.11,76,,284.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",351.42,75,,281.14,,,0,"percent of total billed charges","75% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",281.14,60,,224.91,,,0,"percent of total billed charges","60% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",210.85,45,,168.68,,,0,"percent of total billed charges","45% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",304.56,65,,243.65,,,0,"percent of total billed charges","65% of total billed charges",206.63,27,,165.30,,,0,"percent of total billed charges","27% of total billed charges",445.13,95,,356.10,,,0,"percent of total billed charges","95% of total billed charges",468.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",412.33,88,,329.86,,,0,"percent of total billed charges","88% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",206.63,468.56,
"ADVAIR DISKUS 100/50",2720001986,CDM,250,RC,,,Outpatient,,,468.56,234.28,,468.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",356.11,76,,284.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",351.42,75,,281.14,,,0,"percent of total billed charges","75% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.36,72,,269.89,,,0,"percent of total billed charges","72% of total billed charges",281.14,60,,224.91,,,0,"percent of total billed charges","60% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",210.85,45,,168.68,,,0,"percent of total billed charges","45% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% CMS fee schedule",468.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",304.56,65,,243.65,,,0,"percent of total billed charges","65% of total billed charges",206.63,27,,165.30,,,0,"percent of total billed charges","27% of total billed charges",445.13,95,,356.10,,,0,"percent of total billed charges","95% of total billed charges",468.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",412.33,88,,329.86,,,0,"percent of total billed charges","88% of total billed charges",421.7,90,,337.36,,,0,"percent of total billed charges","90% of total billed charges",206.63,468.56,
"ADVAIR DISKUS 250/50",2720001989,CDM,250,RC,,,Outpatient,,,937.13,468.565,,937.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",712.22,76,,569.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",674.73,72,,539.78,,,0,"percent of total billed charges","72% of total billed charges",702.85,75,,562.28,,,0,"percent of total billed charges","75% of total billed charges",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",674.73,72,,539.78,,,0,"percent of total billed charges","72% of total billed charges",562.28,60,,449.82,,,0,"percent of total billed charges","60% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",421.71,45,,337.37,,,0,"percent of total billed charges","45% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",937.13,100,,,,,0,"fee schedule","100% CMS fee schedule",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",609.13,65,,487.30,,,0,"percent of total billed charges","65% of total billed charges",413.27,27,,330.62,,,0,"percent of total billed charges","27% of total billed charges",890.27,95,,712.22,,,0,"percent of total billed charges","95% of total billed charges",937.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",824.67,88,,659.74,,,0,"percent of total billed charges","88% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",413.27,937.13,
"ADVAIR DISKUS 250/50",2720001990,CDM,250,RC,,,Outpatient,,,937.13,468.565,,937.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",712.22,76,,569.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",674.73,72,,539.78,,,0,"percent of total billed charges","72% of total billed charges",702.85,75,,562.28,,,0,"percent of total billed charges","75% of total billed charges",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",674.73,72,,539.78,,,0,"percent of total billed charges","72% of total billed charges",562.28,60,,449.82,,,0,"percent of total billed charges","60% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",421.71,45,,337.37,,,0,"percent of total billed charges","45% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",937.13,100,,,,,0,"fee schedule","100% CMS fee schedule",937.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",609.13,65,,487.30,,,0,"percent of total billed charges","65% of total billed charges",413.27,27,,330.62,,,0,"percent of total billed charges","27% of total billed charges",890.27,95,,712.22,,,0,"percent of total billed charges","95% of total billed charges",937.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",824.67,88,,659.74,,,0,"percent of total billed charges","88% of total billed charges",843.42,90,,674.74,,,0,"percent of total billed charges","90% of total billed charges",413.27,937.13,
"NASACORT AQ SPRAY",2720001993,CDM,250,RC,,,Outpatient,,,552.35,276.175,,552.35,125,,,,,0,"fee schedule","125% of CMS fee schedule",419.79,76,,335.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",397.69,72,,318.15,,,0,"percent of total billed charges","72% of total billed charges",414.26,75,,331.41,,,0,"percent of total billed charges","75% of total billed charges",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",397.69,72,,318.15,,,0,"percent of total billed charges","72% of total billed charges",331.41,60,,265.13,,,0,"percent of total billed charges","60% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",248.56,45,,198.85,,,0,"percent of total billed charges","45% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",552.35,100,,,,,0,"fee schedule","100% CMS fee schedule",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",359.03,65,,287.22,,,0,"percent of total billed charges","65% of total billed charges",243.59,27,,194.87,,,0,"percent of total billed charges","27% of total billed charges",524.73,95,,419.78,,,0,"percent of total billed charges","95% of total billed charges",552.35,75,,,,,0,"fee schedule","75% of CMS fee schedule",486.07,88,,388.86,,,0,"percent of total billed charges","88% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",243.59,552.35,
"NASACORT AQ SPRAY",2720001994,CDM,250,RC,,,Outpatient,,,552.35,276.175,,552.35,125,,,,,0,"fee schedule","125% of CMS fee schedule",419.79,76,,335.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",397.69,72,,318.15,,,0,"percent of total billed charges","72% of total billed charges",414.26,75,,331.41,,,0,"percent of total billed charges","75% of total billed charges",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",397.69,72,,318.15,,,0,"percent of total billed charges","72% of total billed charges",331.41,60,,265.13,,,0,"percent of total billed charges","60% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",248.56,45,,198.85,,,0,"percent of total billed charges","45% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",552.35,100,,,,,0,"fee schedule","100% CMS fee schedule",552.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",359.03,65,,287.22,,,0,"percent of total billed charges","65% of total billed charges",243.59,27,,194.87,,,0,"percent of total billed charges","27% of total billed charges",524.73,95,,419.78,,,0,"percent of total billed charges","95% of total billed charges",552.35,75,,,,,0,"fee schedule","75% of CMS fee schedule",486.07,88,,388.86,,,0,"percent of total billed charges","88% of total billed charges",497.12,90,,397.70,,,0,"percent of total billed charges","90% of total billed charges",243.59,552.35,
"FLOVENT 44MG INH",2720001997,CDM,250,RC,,,Outpatient,,,582.12,291.06,,582.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",442.41,76,,353.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",419.13,72,,335.30,,,0,"percent of total billed charges","72% of total billed charges",436.59,75,,349.27,,,0,"percent of total billed charges","75% of total billed charges",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",419.13,72,,335.30,,,0,"percent of total billed charges","72% of total billed charges",349.27,60,,279.42,,,0,"percent of total billed charges","60% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",261.95,45,,209.56,,,0,"percent of total billed charges","45% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",582.12,100,,,,,0,"fee schedule","100% CMS fee schedule",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",378.38,65,,302.70,,,0,"percent of total billed charges","65% of total billed charges",256.71,27,,205.37,,,0,"percent of total billed charges","27% of total billed charges",553.01,95,,442.41,,,0,"percent of total billed charges","95% of total billed charges",582.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",512.27,88,,409.82,,,0,"percent of total billed charges","88% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",256.71,582.12,
"FLOVENT 44MG INH",2720001998,CDM,250,RC,,,Outpatient,,,582.12,291.06,,582.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",442.41,76,,353.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",419.13,72,,335.30,,,0,"percent of total billed charges","72% of total billed charges",436.59,75,,349.27,,,0,"percent of total billed charges","75% of total billed charges",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",419.13,72,,335.30,,,0,"percent of total billed charges","72% of total billed charges",349.27,60,,279.42,,,0,"percent of total billed charges","60% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",261.95,45,,209.56,,,0,"percent of total billed charges","45% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",582.12,100,,,,,0,"fee schedule","100% CMS fee schedule",582.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",378.38,65,,302.70,,,0,"percent of total billed charges","65% of total billed charges",256.71,27,,205.37,,,0,"percent of total billed charges","27% of total billed charges",553.01,95,,442.41,,,0,"percent of total billed charges","95% of total billed charges",582.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",512.27,88,,409.82,,,0,"percent of total billed charges","88% of total billed charges",523.91,90,,419.13,,,0,"percent of total billed charges","90% of total billed charges",256.71,582.12,
"FLOVENT 110MCG INJ",2720002001,CDM,250,RC,,,Outpatient,,,779.47,389.735,,779.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",592.4,76,,473.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",561.22,72,,448.98,,,0,"percent of total billed charges","72% of total billed charges",584.6,75,,467.68,,,0,"percent of total billed charges","75% of total billed charges",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",561.22,72,,448.98,,,0,"percent of total billed charges","72% of total billed charges",467.68,60,,374.14,,,0,"percent of total billed charges","60% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",350.76,45,,280.61,,,0,"percent of total billed charges","45% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",779.47,100,,,,,0,"fee schedule","100% CMS fee schedule",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.66,65,,405.33,,,0,"percent of total billed charges","65% of total billed charges",343.75,27,,275.00,,,0,"percent of total billed charges","27% of total billed charges",740.5,95,,592.40,,,0,"percent of total billed charges","95% of total billed charges",779.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",685.93,88,,548.74,,,0,"percent of total billed charges","88% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",343.75,779.47,
"FLOVENT 110MCG INJ",2720002002,CDM,250,RC,,,Outpatient,,,779.47,389.735,,779.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",592.4,76,,473.92,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",561.22,72,,448.98,,,0,"percent of total billed charges","72% of total billed charges",584.6,75,,467.68,,,0,"percent of total billed charges","75% of total billed charges",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",561.22,72,,448.98,,,0,"percent of total billed charges","72% of total billed charges",467.68,60,,374.14,,,0,"percent of total billed charges","60% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",350.76,45,,280.61,,,0,"percent of total billed charges","45% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",779.47,100,,,,,0,"fee schedule","100% CMS fee schedule",779.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",506.66,65,,405.33,,,0,"percent of total billed charges","65% of total billed charges",343.75,27,,275.00,,,0,"percent of total billed charges","27% of total billed charges",740.5,95,,592.40,,,0,"percent of total billed charges","95% of total billed charges",779.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",685.93,88,,548.74,,,0,"percent of total billed charges","88% of total billed charges",701.52,90,,561.22,,,0,"percent of total billed charges","90% of total billed charges",343.75,779.47,
"HEMABATE 250MCG INJ",2720002005,CDM,250,RC,,,Outpatient,,,635.04,317.52,,635.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",482.63,76,,386.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",457.23,72,,365.78,,,0,"percent of total billed charges","72% of total billed charges",476.28,75,,381.02,,,0,"percent of total billed charges","75% of total billed charges",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",457.23,72,,365.78,,,0,"percent of total billed charges","72% of total billed charges",381.02,60,,304.82,,,0,"percent of total billed charges","60% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",285.77,45,,228.62,,,0,"percent of total billed charges","45% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",635.04,100,,,,,0,"fee schedule","100% CMS fee schedule",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",412.78,65,,330.22,,,0,"percent of total billed charges","65% of total billed charges",280.05,27,,224.04,,,0,"percent of total billed charges","27% of total billed charges",603.29,95,,482.63,,,0,"percent of total billed charges","95% of total billed charges",635.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",558.84,88,,447.07,,,0,"percent of total billed charges","88% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",280.05,635.04,
"HEMABATE 250MCG INJ",2720002006,CDM,250,RC,,,Outpatient,,,635.04,317.52,,635.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",482.63,76,,386.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",457.23,72,,365.78,,,0,"percent of total billed charges","72% of total billed charges",476.28,75,,381.02,,,0,"percent of total billed charges","75% of total billed charges",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",457.23,72,,365.78,,,0,"percent of total billed charges","72% of total billed charges",381.02,60,,304.82,,,0,"percent of total billed charges","60% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",285.77,45,,228.62,,,0,"percent of total billed charges","45% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",635.04,100,,,,,0,"fee schedule","100% CMS fee schedule",635.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",412.78,65,,330.22,,,0,"percent of total billed charges","65% of total billed charges",280.05,27,,224.04,,,0,"percent of total billed charges","27% of total billed charges",603.29,95,,482.63,,,0,"percent of total billed charges","95% of total billed charges",635.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",558.84,88,,447.07,,,0,"percent of total billed charges","88% of total billed charges",571.54,90,,457.23,,,0,"percent of total billed charges","90% of total billed charges",280.05,635.04,
"SANDOSTATIN 0.05MCG",2720002009,CDM,250,RC,J2354,HCPCS,Outpatient,,,51.82,25.91,U8,51.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",39.38,76,,31.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.09,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",1.09,350,,,,,0,"fee schedule","350% of BCBS fee schedule",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.09,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.31,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",23.32,45,,18.66,,,0,"percent of total billed charges","45% of total billed charges",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.82,100,,,,,0,"fee schedule","100% CMS fee schedule",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.68,65,,26.94,,,0,"percent of total billed charges","65% of total billed charges",22.85,27,,18.28,,,0,"percent of total billed charges","27% of total billed charges",49.23,95,,39.38,,,0,"percent of total billed charges","95% of total billed charges",51.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",45.6,88,,36.48,,,0,"percent of total billed charges","88% of total billed charges",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",0.31,51.82,
"SANDOSTATIN 0.05MCG",2720002010,CDM,250,RC,J2354,HCPCS,Outpatient,,,51.82,25.91,U8,51.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",39.38,76,,31.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.09,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",1.09,350,,,,,0,"fee schedule","350% of BCBS fee schedule",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.09,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.31,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",23.32,45,,18.66,,,0,"percent of total billed charges","45% of total billed charges",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.82,100,,,,,0,"fee schedule","100% CMS fee schedule",51.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.68,65,,26.94,,,0,"percent of total billed charges","65% of total billed charges",22.85,27,,18.28,,,0,"percent of total billed charges","27% of total billed charges",49.23,95,,39.38,,,0,"percent of total billed charges","95% of total billed charges",51.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",45.6,88,,36.48,,,0,"percent of total billed charges","88% of total billed charges",46.64,90,,37.31,,,0,"percent of total billed charges","90% of total billed charges",0.31,51.82,
"BREVIBLOC 250MG INJ",2720002013,CDM,250,RC,,,Outpatient,,,604.17,302.085,,604.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",459.17,76,,367.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",435,72,,348.00,,,0,"percent of total billed charges","72% of total billed charges",453.13,75,,362.50,,,0,"percent of total billed charges","75% of total billed charges",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",435,72,,348.00,,,0,"percent of total billed charges","72% of total billed charges",362.5,60,,290.00,,,0,"percent of total billed charges","60% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",271.88,45,,217.50,,,0,"percent of total billed charges","45% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",604.17,100,,,,,0,"fee schedule","100% CMS fee schedule",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",392.71,65,,314.17,,,0,"percent of total billed charges","65% of total billed charges",266.44,27,,213.15,,,0,"percent of total billed charges","27% of total billed charges",573.96,95,,459.17,,,0,"percent of total billed charges","95% of total billed charges",604.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",531.67,88,,425.34,,,0,"percent of total billed charges","88% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",266.44,604.17,
"BREVIBLOC 250MG INJ",2720002014,CDM,250,RC,,,Outpatient,,,604.17,302.085,,604.17,125,,,,,0,"fee schedule","125% of CMS fee schedule",459.17,76,,367.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",435,72,,348.00,,,0,"percent of total billed charges","72% of total billed charges",453.13,75,,362.50,,,0,"percent of total billed charges","75% of total billed charges",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",435,72,,348.00,,,0,"percent of total billed charges","72% of total billed charges",362.5,60,,290.00,,,0,"percent of total billed charges","60% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",271.88,45,,217.50,,,0,"percent of total billed charges","45% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",604.17,100,,,,,0,"fee schedule","100% CMS fee schedule",604.17,100,,,,,0,"fee schedule","100% of CMS fee schedule",392.71,65,,314.17,,,0,"percent of total billed charges","65% of total billed charges",266.44,27,,213.15,,,0,"percent of total billed charges","27% of total billed charges",573.96,95,,459.17,,,0,"percent of total billed charges","95% of total billed charges",604.17,75,,,,,0,"fee schedule","75% of CMS fee schedule",531.67,88,,425.34,,,0,"percent of total billed charges","88% of total billed charges",543.75,90,,435.00,,,0,"percent of total billed charges","90% of total billed charges",266.44,604.17,
"VIGAMOX 0.5% OPHTH D",2720002017,CDM,250,RC,,,Outpatient,,,413.44,206.72,,413.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",314.21,76,,251.37,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",297.68,72,,238.14,,,0,"percent of total billed charges","72% of total billed charges",310.08,75,,248.06,,,0,"percent of total billed charges","75% of total billed charges",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.68,72,,238.14,,,0,"percent of total billed charges","72% of total billed charges",248.06,60,,198.45,,,0,"percent of total billed charges","60% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",186.05,45,,148.84,,,0,"percent of total billed charges","45% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",413.44,100,,,,,0,"fee schedule","100% CMS fee schedule",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",268.74,65,,214.99,,,0,"percent of total billed charges","65% of total billed charges",182.33,27,,145.86,,,0,"percent of total billed charges","27% of total billed charges",392.77,95,,314.22,,,0,"percent of total billed charges","95% of total billed charges",413.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",363.83,88,,291.06,,,0,"percent of total billed charges","88% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",182.33,413.44,
"VIGAMOX 0.5% OPHTH D",2720002018,CDM,250,RC,,,Outpatient,,,413.44,206.72,,413.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",314.21,76,,251.37,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",297.68,72,,238.14,,,0,"percent of total billed charges","72% of total billed charges",310.08,75,,248.06,,,0,"percent of total billed charges","75% of total billed charges",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",297.68,72,,238.14,,,0,"percent of total billed charges","72% of total billed charges",248.06,60,,198.45,,,0,"percent of total billed charges","60% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",186.05,45,,148.84,,,0,"percent of total billed charges","45% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",413.44,100,,,,,0,"fee schedule","100% CMS fee schedule",413.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",268.74,65,,214.99,,,0,"percent of total billed charges","65% of total billed charges",182.33,27,,145.86,,,0,"percent of total billed charges","27% of total billed charges",392.77,95,,314.22,,,0,"percent of total billed charges","95% of total billed charges",413.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",363.83,88,,291.06,,,0,"percent of total billed charges","88% of total billed charges",372.1,90,,297.68,,,0,"percent of total billed charges","90% of total billed charges",182.33,413.44,
"VAPRISOL DEX 5% 20MG",2720002021,CDM,250,RC,,,Outpatient,,,3141.02,1570.51,,3141.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",2387.18,76,,1909.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2261.53,72,,1809.22,,,0,"percent of total billed charges","72% of total billed charges",2355.77,75,,1884.62,,,0,"percent of total billed charges","75% of total billed charges",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2261.53,72,,1809.22,,,0,"percent of total billed charges","72% of total billed charges",1884.61,60,,1507.69,,,0,"percent of total billed charges","60% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",1413.46,45,,1130.77,,,0,"percent of total billed charges","45% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3141.02,100,,,,,0,"fee schedule","100% CMS fee schedule",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2041.66,65,,1633.33,,,0,"percent of total billed charges","65% of total billed charges",1385.19,27,,1108.15,,,0,"percent of total billed charges","27% of total billed charges",2983.97,95,,2387.18,,,0,"percent of total billed charges","95% of total billed charges",3141.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",2764.1,88,,2211.28,,,0,"percent of total billed charges","88% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",1385.19,3141.02,
"VAPRISOL DEX 5% 20MG",2720002022,CDM,250,RC,,,Outpatient,,,3141.02,1570.51,,3141.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",2387.18,76,,1909.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2261.53,72,,1809.22,,,0,"percent of total billed charges","72% of total billed charges",2355.77,75,,1884.62,,,0,"percent of total billed charges","75% of total billed charges",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2261.53,72,,1809.22,,,0,"percent of total billed charges","72% of total billed charges",1884.61,60,,1507.69,,,0,"percent of total billed charges","60% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",1413.46,45,,1130.77,,,0,"percent of total billed charges","45% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",3141.02,100,,,,,0,"fee schedule","100% CMS fee schedule",3141.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",2041.66,65,,1633.33,,,0,"percent of total billed charges","65% of total billed charges",1385.19,27,,1108.15,,,0,"percent of total billed charges","27% of total billed charges",2983.97,95,,2387.18,,,0,"percent of total billed charges","95% of total billed charges",3141.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",2764.1,88,,2211.28,,,0,"percent of total billed charges","88% of total billed charges",2826.92,90,,2261.54,,,0,"percent of total billed charges","90% of total billed charges",1385.19,3141.02,
"CUROSURF 240MG/3ML V",2720002025,CDM,250,RC,,,Outpatient,,,1280,640,,1280,125,,,,,0,"fee schedule","125% of CMS fee schedule",972.8,76,,778.24,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",921.6,72,,737.28,,,0,"percent of total billed charges","72% of total billed charges",960,75,,768.00,,,0,"percent of total billed charges","75% of total billed charges",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",921.6,72,,737.28,,,0,"percent of total billed charges","72% of total billed charges",768,60,,614.40,,,0,"percent of total billed charges","60% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",576,45,,460.80,,,0,"percent of total billed charges","45% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",1280,100,,,,,0,"fee schedule","100% CMS fee schedule",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",832,65,,665.60,,,0,"percent of total billed charges","65% of total billed charges",564.48,27,,451.58,,,0,"percent of total billed charges","27% of total billed charges",1216,95,,972.80,,,0,"percent of total billed charges","95% of total billed charges",1280,75,,,,,0,"fee schedule","75% of CMS fee schedule",1126.4,88,,901.12,,,0,"percent of total billed charges","88% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",564.48,1280,
"CUROSURF 240MG/3ML V",2720002026,CDM,250,RC,,,Outpatient,,,1280,640,,1280,125,,,,,0,"fee schedule","125% of CMS fee schedule",972.8,76,,778.24,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",921.6,72,,737.28,,,0,"percent of total billed charges","72% of total billed charges",960,75,,768.00,,,0,"percent of total billed charges","75% of total billed charges",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",921.6,72,,737.28,,,0,"percent of total billed charges","72% of total billed charges",768,60,,614.40,,,0,"percent of total billed charges","60% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",576,45,,460.80,,,0,"percent of total billed charges","45% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",1280,100,,,,,0,"fee schedule","100% CMS fee schedule",1280,100,,,,,0,"fee schedule","100% of CMS fee schedule",832,65,,665.60,,,0,"percent of total billed charges","65% of total billed charges",564.48,27,,451.58,,,0,"percent of total billed charges","27% of total billed charges",1216,95,,972.80,,,0,"percent of total billed charges","95% of total billed charges",1280,75,,,,,0,"fee schedule","75% of CMS fee schedule",1126.4,88,,901.12,,,0,"percent of total billed charges","88% of total billed charges",1152,90,,921.60,,,0,"percent of total billed charges","90% of total billed charges",564.48,1280,
"BREVIBLOC 2500MG/250",2720002029,CDM,250,RC,,,Outpatient,,,820.26,410.13,,820.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",623.4,76,,498.72,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",590.59,72,,472.47,,,0,"percent of total billed charges","72% of total billed charges",615.2,75,,492.16,,,0,"percent of total billed charges","75% of total billed charges",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",590.59,72,,472.47,,,0,"percent of total billed charges","72% of total billed charges",492.16,60,,393.73,,,0,"percent of total billed charges","60% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",369.12,45,,295.30,,,0,"percent of total billed charges","45% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.26,100,,,,,0,"fee schedule","100% CMS fee schedule",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",533.17,65,,426.54,,,0,"percent of total billed charges","65% of total billed charges",361.73,27,,289.38,,,0,"percent of total billed charges","27% of total billed charges",779.25,95,,623.40,,,0,"percent of total billed charges","95% of total billed charges",820.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",721.83,88,,577.46,,,0,"percent of total billed charges","88% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",361.73,820.26,
"BREVIBLOC 2500MG/250",2720002030,CDM,250,RC,,,Outpatient,,,820.26,410.13,,820.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",623.4,76,,498.72,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",590.59,72,,472.47,,,0,"percent of total billed charges","72% of total billed charges",615.2,75,,492.16,,,0,"percent of total billed charges","75% of total billed charges",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",590.59,72,,472.47,,,0,"percent of total billed charges","72% of total billed charges",492.16,60,,393.73,,,0,"percent of total billed charges","60% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",369.12,45,,295.30,,,0,"percent of total billed charges","45% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",820.26,100,,,,,0,"fee schedule","100% CMS fee schedule",820.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",533.17,65,,426.54,,,0,"percent of total billed charges","65% of total billed charges",361.73,27,,289.38,,,0,"percent of total billed charges","27% of total billed charges",779.25,95,,623.40,,,0,"percent of total billed charges","95% of total billed charges",820.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",721.83,88,,577.46,,,0,"percent of total billed charges","88% of total billed charges",738.23,90,,590.58,,,0,"percent of total billed charges","90% of total billed charges",361.73,820.26,
"ANGIOMAX 250MG INJ",2720002033,CDM,250,RC,J0583,HCPCS,Outpatient,,,4073.74,2036.87,U8,4073.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",3096.04,76,,2476.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.08,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.08,350,,,,,0,"fee schedule","350% of BCBS fee schedule",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.45,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",1833.18,45,,1466.54,,,0,"percent of total billed charges","45% of total billed charges",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4073.74,100,,,,,0,"fee schedule","100% CMS fee schedule",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",2647.93,65,,2118.34,,,0,"percent of total billed charges","65% of total billed charges",1796.52,27,,1437.22,,,0,"percent of total billed charges","27% of total billed charges",3870.05,95,,3096.04,,,0,"percent of total billed charges","95% of total billed charges",4073.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",3584.89,88,,2867.91,,,0,"percent of total billed charges","88% of total billed charges",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",1.45,4073.74,
"ANGIOMAX 250MG INJ",2720002034,CDM,250,RC,J0583,HCPCS,Outpatient,,,4073.74,2036.87,U8,4073.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",3096.04,76,,2476.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.08,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.08,350,,,,,0,"fee schedule","350% of BCBS fee schedule",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.08,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.45,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",1833.18,45,,1466.54,,,0,"percent of total billed charges","45% of total billed charges",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",4073.74,100,,,,,0,"fee schedule","100% CMS fee schedule",4073.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",2647.93,65,,2118.34,,,0,"percent of total billed charges","65% of total billed charges",1796.52,27,,1437.22,,,0,"percent of total billed charges","27% of total billed charges",3870.05,95,,3096.04,,,0,"percent of total billed charges","95% of total billed charges",4073.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",3584.89,88,,2867.91,,,0,"percent of total billed charges","88% of total billed charges",3666.37,90,,2933.10,,,0,"percent of total billed charges","90% of total billed charges",1.45,4073.74,
"NITROLINGUAL SPRAY 12GM",2720002037,CDM,250,RC,,,Outpatient,,,921.75,460.875,,921.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",700.53,76,,560.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",663.66,72,,530.93,,,0,"percent of total billed charges","72% of total billed charges",691.31,75,,553.05,,,0,"percent of total billed charges","75% of total billed charges",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",663.66,72,,530.93,,,0,"percent of total billed charges","72% of total billed charges",553.05,60,,442.44,,,0,"percent of total billed charges","60% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",414.79,45,,331.83,,,0,"percent of total billed charges","45% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",921.75,100,,,,,0,"fee schedule","100% CMS fee schedule",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",599.14,65,,479.31,,,0,"percent of total billed charges","65% of total billed charges",406.49,27,,325.19,,,0,"percent of total billed charges","27% of total billed charges",875.66,95,,700.53,,,0,"percent of total billed charges","95% of total billed charges",921.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",811.14,88,,648.91,,,0,"percent of total billed charges","88% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",406.49,921.75,
"NITROLINGUAL SPRAY 12GM",2720002038,CDM,250,RC,,,Outpatient,,,921.75,460.875,,921.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",700.53,76,,560.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",663.66,72,,530.93,,,0,"percent of total billed charges","72% of total billed charges",691.31,75,,553.05,,,0,"percent of total billed charges","75% of total billed charges",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",663.66,72,,530.93,,,0,"percent of total billed charges","72% of total billed charges",553.05,60,,442.44,,,0,"percent of total billed charges","60% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",414.79,45,,331.83,,,0,"percent of total billed charges","45% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",921.75,100,,,,,0,"fee schedule","100% CMS fee schedule",921.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",599.14,65,,479.31,,,0,"percent of total billed charges","65% of total billed charges",406.49,27,,325.19,,,0,"percent of total billed charges","27% of total billed charges",875.66,95,,700.53,,,0,"percent of total billed charges","95% of total billed charges",921.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",811.14,88,,648.91,,,0,"percent of total billed charges","88% of total billed charges",829.58,90,,663.66,,,0,"percent of total billed charges","90% of total billed charges",406.49,921.75,
"OFLOXACIN 0.3% 5ML OTIC",2720002041,CDM,250,RC,,,Outpatient,,,450,225,,450,125,,,,,0,"fee schedule","125% of CMS fee schedule",342,76,,273.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",324,72,,259.20,,,0,"percent of total billed charges","72% of total billed charges",337.5,75,,270.00,,,0,"percent of total billed charges","75% of total billed charges",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",324,72,,259.20,,,0,"percent of total billed charges","72% of total billed charges",270,60,,216.00,,,0,"percent of total billed charges","60% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",202.5,45,,162.00,,,0,"percent of total billed charges","45% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",450,100,,,,,0,"fee schedule","100% CMS fee schedule",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",292.5,65,,234.00,,,0,"percent of total billed charges","65% of total billed charges",198.45,27,,158.76,,,0,"percent of total billed charges","27% of total billed charges",427.5,95,,342.00,,,0,"percent of total billed charges","95% of total billed charges",450,75,,,,,0,"fee schedule","75% of CMS fee schedule",396,88,,316.80,,,0,"percent of total billed charges","88% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",198.45,450,
"OFLOXACIN 0.3% 5ML OTIC",2720002042,CDM,250,RC,,,Outpatient,,,450,225,,450,125,,,,,0,"fee schedule","125% of CMS fee schedule",342,76,,273.60,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",324,72,,259.20,,,0,"percent of total billed charges","72% of total billed charges",337.5,75,,270.00,,,0,"percent of total billed charges","75% of total billed charges",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",324,72,,259.20,,,0,"percent of total billed charges","72% of total billed charges",270,60,,216.00,,,0,"percent of total billed charges","60% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",202.5,45,,162.00,,,0,"percent of total billed charges","45% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",450,100,,,,,0,"fee schedule","100% CMS fee schedule",450,100,,,,,0,"fee schedule","100% of CMS fee schedule",292.5,65,,234.00,,,0,"percent of total billed charges","65% of total billed charges",198.45,27,,158.76,,,0,"percent of total billed charges","27% of total billed charges",427.5,95,,342.00,,,0,"percent of total billed charges","95% of total billed charges",450,75,,,,,0,"fee schedule","75% of CMS fee schedule",396,88,,316.80,,,0,"percent of total billed charges","88% of total billed charges",405,90,,324.00,,,0,"percent of total billed charges","90% of total billed charges",198.45,450,
"STERILE H2O FOR INJ 1000ML",2720002045,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"STERILE H2O FOR INJ 1000ML",2720002046,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"STERIL H2O FOR INJ 10ML",2720002049,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"STERIL H2O FOR INJ 10ML",2720002050,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"D10W 250 ML SOLN",2720002053,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"D10W 250 ML SOLN",2720002054,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"SOD CHLORIDE FOR INJ 10ML",2720002057,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"SOD CHLORIDE FOR INJ 10ML",2720002058,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"D10W 500ML/1000ML",2720002077,CDM,250,RC,,,Outpatient,,,132.3,66.15,,132.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",100.55,76,,80.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",95.26,72,,76.21,,,0,"percent of total billed charges","72% of total billed charges",99.23,75,,79.38,,,0,"percent of total billed charges","75% of total billed charges",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.26,72,,76.21,,,0,"percent of total billed charges","72% of total billed charges",79.38,60,,63.50,,,0,"percent of total billed charges","60% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",59.54,45,,47.63,,,0,"percent of total billed charges","45% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,65,,68.80,,,0,"percent of total billed charges","65% of total billed charges",58.34,27,,46.67,,,0,"percent of total billed charges","27% of total billed charges",125.69,95,,100.55,,,0,"percent of total billed charges","95% of total billed charges",132.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",116.42,88,,93.14,,,0,"percent of total billed charges","88% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",58.34,132.3,
"D10W 500ML/1000ML",2720002078,CDM,250,RC,,,Outpatient,,,132.3,66.15,,132.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",100.55,76,,80.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",95.26,72,,76.21,,,0,"percent of total billed charges","72% of total billed charges",99.23,75,,79.38,,,0,"percent of total billed charges","75% of total billed charges",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.26,72,,76.21,,,0,"percent of total billed charges","72% of total billed charges",79.38,60,,63.50,,,0,"percent of total billed charges","60% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",59.54,45,,47.63,,,0,"percent of total billed charges","45% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,65,,68.80,,,0,"percent of total billed charges","65% of total billed charges",58.34,27,,46.67,,,0,"percent of total billed charges","27% of total billed charges",125.69,95,,100.55,,,0,"percent of total billed charges","95% of total billed charges",132.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",116.42,88,,93.14,,,0,"percent of total billed charges","88% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",58.34,132.3,
"D10W 1/4NS 250 ML SOLN",2720002081,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"D10W 1/4NS 250 ML SOLN",2720002082,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"D10W 1/4NS 500 ML SOLN",2720002085,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"D10W 1/4NS 500 ML SOLN",2720002086,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"500CC D5 LR IV SOLN",2720002089,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"500CC D5 LR IV SOLN",2720002090,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"1000CC D5 LR IV SOLN",2720002093,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"1000CC D5 LR IV SOLN",2720002094,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"DEXTROSE 50% 500ML IV SOLN",2720002097,CDM,250,RC,,,Outpatient,,,195.14,97.57,,195.14,125,,,,,0,"fee schedule","125% of CMS fee schedule",148.31,76,,118.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",140.5,72,,112.40,,,0,"percent of total billed charges","72% of total billed charges",146.36,75,,117.09,,,0,"percent of total billed charges","75% of total billed charges",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.5,72,,112.40,,,0,"percent of total billed charges","72% of total billed charges",117.08,60,,93.66,,,0,"percent of total billed charges","60% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",87.81,45,,70.25,,,0,"percent of total billed charges","45% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.14,100,,,,,0,"fee schedule","100% CMS fee schedule",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.84,65,,101.47,,,0,"percent of total billed charges","65% of total billed charges",86.06,27,,68.85,,,0,"percent of total billed charges","27% of total billed charges",185.38,95,,148.30,,,0,"percent of total billed charges","95% of total billed charges",195.14,75,,,,,0,"fee schedule","75% of CMS fee schedule",171.72,88,,137.38,,,0,"percent of total billed charges","88% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",86.06,195.14,
"DEXTROSE 50% 500ML IV SOLN",2720002098,CDM,250,RC,,,Outpatient,,,195.14,97.57,,195.14,125,,,,,0,"fee schedule","125% of CMS fee schedule",148.31,76,,118.65,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",140.5,72,,112.40,,,0,"percent of total billed charges","72% of total billed charges",146.36,75,,117.09,,,0,"percent of total billed charges","75% of total billed charges",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",140.5,72,,112.40,,,0,"percent of total billed charges","72% of total billed charges",117.08,60,,93.66,,,0,"percent of total billed charges","60% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",87.81,45,,70.25,,,0,"percent of total billed charges","45% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",195.14,100,,,,,0,"fee schedule","100% CMS fee schedule",195.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.84,65,,101.47,,,0,"percent of total billed charges","65% of total billed charges",86.06,27,,68.85,,,0,"percent of total billed charges","27% of total billed charges",185.38,95,,148.30,,,0,"percent of total billed charges","95% of total billed charges",195.14,75,,,,,0,"fee schedule","75% of CMS fee schedule",171.72,88,,137.38,,,0,"percent of total billed charges","88% of total billed charges",175.63,90,,140.50,,,0,"percent of total billed charges","90% of total billed charges",86.06,195.14,
"3% SOD CHLORIDE 500ML SOLN",2720002101,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"3% SOD CHLORIDE 500ML SOLN",2720002102,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"CARDIZEM 5MG/ML INJ",2720002105,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CARDIZEM 5MG/ML INJ",2720002106,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"CARDIZEM 5MG/ML INJ",2720002109,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"CARDIZEM 5MG/ML INJ",2720002110,CDM,250,RC,,,Outpatient,,,26.46,13.23,,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,16.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,15.88,,,0,"percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,9.34,,,0,"percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,18.62,,,0,"percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"CLEOCIN 900MG INJ",2720002113,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"CLEOCIN 900MG INJ",2720002114,CDM,250,RC,,,Outpatient,,,27.56,13.78,,27.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.95,76,,16.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",20.67,75,,16.54,,,0,"percent of total billed charges","75% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.84,72,,15.87,,,0,"percent of total billed charges","72% of total billed charges",16.54,60,,13.23,,,0,"percent of total billed charges","60% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.4,45,,9.92,,,0,"percent of total billed charges","45% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% CMS fee schedule",27.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.91,65,,14.33,,,0,"percent of total billed charges","65% of total billed charges",12.15,27,,9.72,,,0,"percent of total billed charges","27% of total billed charges",26.18,95,,20.94,,,0,"percent of total billed charges","95% of total billed charges",27.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",24.25,88,,19.40,,,0,"percent of total billed charges","88% of total billed charges",24.8,90,,19.84,,,0,"percent of total billed charges","90% of total billed charges",12.15,27.56,
"LIDO W/EPI 1PCT 20ML INJ",2720002117,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LIDO W/EPI 1PCT 20ML INJ",2720002118,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LABETALOL 100MG/20ML INJ",2720002121,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"LABETALOL 100MG/20ML INJ",2720002122,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"NEXTERONE 150 MG/100ML INJ",2720002125,CDM,250,RC,J0282,HCPCS,Outpatient,,,179.71,89.855,U8,179.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",136.58,76,,109.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.7,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS fee schedule",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",80.87,45,,64.70,,,0,"percent of total billed charges","45% of total billed charges",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.71,100,,,,,0,"fee schedule","100% CMS fee schedule",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.81,65,,93.45,,,0,"percent of total billed charges","65% of total billed charges",79.25,27,,63.40,,,0,"percent of total billed charges","27% of total billed charges",170.72,95,,136.58,,,0,"percent of total billed charges","95% of total billed charges",179.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",158.14,88,,10.56,10.56,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",0.2,179.71,
"NEXTERONE 150 MG/100ML INJ",2720002126,CDM,250,RC,,,Outpatient,,,179.71,89.855,,179.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",136.58,76,,109.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",129.39,72,,103.51,,,0,"percent of total billed charges","72% of total billed charges",134.78,75,,107.82,,,0,"percent of total billed charges","75% of total billed charges",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",129.39,72,,103.51,,,0,"percent of total billed charges","72% of total billed charges",107.83,60,,86.26,,,0,"percent of total billed charges","60% of total billed charges",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",80.87,45,,64.70,,,0,"percent of total billed charges","45% of total billed charges",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.71,100,,,,,0,"fee schedule","100% CMS fee schedule",179.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",116.81,65,,93.45,,,0,"percent of total billed charges","65% of total billed charges",79.25,27,,63.40,,,0,"percent of total billed charges","27% of total billed charges",170.72,95,,136.58,,,0,"percent of total billed charges","95% of total billed charges",179.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",158.14,88,,126.51,,,0,"percent of total billed charges","88% of total billed charges",161.74,90,,129.39,,,0,"percent of total billed charges","90% of total billed charges",79.25,179.71,
"LIDO 2GM/500ML INJ",2720002129,CDM,250,RC,J2002,HCPCS,Outpatient,,,126.79,63.395,U8,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,0.10,0.10,0.10,15,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,7.95,7.29,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,0.07,0.03,0.11,"1 through 10","fee schedule","75% of CMS fee schedule",111.58,88,,6.35,1.37,11.33,"1 through 10","percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"LIDO 2GM/500ML INJ",2720002130,CDM,250,RC,J2002,HCPCS,Outpatient,,,126.79,63.395,U8,126.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",96.36,76,,77.09,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",95.09,75,,76.07,,,0,"percent of total billed charges","75% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.29,72,,73.03,,,0,"percent of total billed charges","72% of total billed charges",76.07,60,,60.86,,,0,"percent of total billed charges","60% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",57.06,45,,45.65,,,0,"percent of total billed charges","45% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",126.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.79,100,,,,,0,"fee schedule","100% CMS fee schedule",126.79,100,,0.10,0.10,0.10,15,"fee schedule","100% of CMS fee schedule",82.41,65,,65.93,,,0,"percent of total billed charges","65% of total billed charges",55.91,27,,7.95,7.29,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",120.45,95,,96.36,,,0,"percent of total billed charges","95% of total billed charges",126.79,75,,0.07,0.03,0.11,"1 through 10","fee schedule","75% of CMS fee schedule",111.58,88,,6.35,1.37,11.33,"1 through 10","percent of total billed charges","88% of total billed charges",114.11,90,,91.29,,,0,"percent of total billed charges","90% of total billed charges",55.91,126.79,
"LIDO 1PCT 20ML VL INJ",2720002133,CDM,250,RC,J2003,HCPCS,Outpatient,,,7.72,3.86,U8,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",6.79,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LIDO 1PCT 20ML VL INJ",2720002134,CDM,250,RC,J2003,HCPCS,Outpatient,,,7.72,3.86,U8,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",6.79,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"LIDO WEPI 2PCT 10ML INJ",2720002137,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"LIDO WEPI 2PCT 10ML INJ",2720002138,CDM,250,RC,,,Outpatient,,,44.1,22.05,,44.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",33.52,76,,26.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",33.08,75,,26.46,,,0,"percent of total billed charges","75% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.75,72,,25.40,,,0,"percent of total billed charges","72% of total billed charges",26.46,60,,21.17,,,0,"percent of total billed charges","60% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,,15.88,,,0,"percent of total billed charges","45% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% CMS fee schedule",44.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.67,65,,22.94,,,0,"percent of total billed charges","65% of total billed charges",19.45,27,,15.56,,,0,"percent of total billed charges","27% of total billed charges",41.9,95,,33.52,,,0,"percent of total billed charges","95% of total billed charges",44.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",38.81,88,,31.05,,,0,"percent of total billed charges","88% of total billed charges",39.69,90,,31.75,,,0,"percent of total billed charges","90% of total billed charges",19.45,44.1,
"LIDOCAINE HCL 2% 10ML INJ",2720002141,CDM,250,RC,J2003,HCPCS,Outpatient,,,35.28,17.64,U8,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",31.05,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"LIDOCAINE HCL 2% 10ML INJ",2720002142,CDM,250,RC,J2003,HCPCS,Outpatient,,,35.28,17.64,U8,35.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",26.81,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",26.46,75,,21.17,,,0,"percent of total billed charges","75% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.4,72,,20.32,,,0,"percent of total billed charges","72% of total billed charges",21.17,60,,16.94,,,0,"percent of total billed charges","60% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.88,45,,12.70,,,0,"percent of total billed charges","45% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% CMS fee schedule",35.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.93,65,,18.34,,,0,"percent of total billed charges","65% of total billed charges",15.56,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",33.52,95,,26.82,,,0,"percent of total billed charges","95% of total billed charges",35.28,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",31.05,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",31.75,90,,25.40,,,0,"percent of total billed charges","90% of total billed charges",15.56,35.28,
"LIDOCAINE HCL 2% 20 ML INJ",2720002145,CDM,250,RC,J2002,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,0.10,0.10,0.10,15,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,7.95,7.29,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,0.07,0.03,0.11,"1 through 10","fee schedule","75% of CMS fee schedule",9.71,88,,6.35,1.37,11.33,"1 through 10","percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"LIDOCAINE HCL 2% 20 ML INJ",2720002146,CDM,250,RC,J2002,HCPCS,Outpatient,,,11.03,5.515,U8,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,0.10,0.10,0.10,15,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,7.95,7.29,8.60,"1 through 10","percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,0.07,0.03,0.11,"1 through 10","fee schedule","75% of CMS fee schedule",9.71,88,,6.35,1.37,11.33,"1 through 10","percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"BUPIVACAINEMPF/EPIN INJ",2720002149,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"BUPIVACAINEMPF/EPIN INJ",2720002150,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"BUPIVACAINEMPF/EPIN INJ",2720002153,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"BUPIVACAINEMPF/EPIN INJ",2720002154,CDM,250,RC,,,Outpatient,,,45.2,22.6,,45.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.35,76,,27.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",33.9,75,,27.12,,,0,"percent of total billed charges","75% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.54,72,,26.03,,,0,"percent of total billed charges","72% of total billed charges",27.12,60,,21.70,,,0,"percent of total billed charges","60% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",20.34,45,,16.27,,,0,"percent of total billed charges","45% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% CMS fee schedule",45.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.38,65,,23.50,,,0,"percent of total billed charges","65% of total billed charges",19.93,27,,15.94,,,0,"percent of total billed charges","27% of total billed charges",42.94,95,,34.35,,,0,"percent of total billed charges","95% of total billed charges",45.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.78,88,,31.82,,,0,"percent of total billed charges","88% of total billed charges",40.68,90,,32.54,,,0,"percent of total billed charges","90% of total billed charges",19.93,45.2,
"D10W 500ML SOLN",2720002157,CDM,250,RC,,,Outpatient,,,174.2,87.1,,174.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",132.39,76,,105.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",125.42,72,,100.34,,,0,"percent of total billed charges","72% of total billed charges",130.65,75,,104.52,,,0,"percent of total billed charges","75% of total billed charges",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.42,72,,100.34,,,0,"percent of total billed charges","72% of total billed charges",104.52,60,,83.62,,,0,"percent of total billed charges","60% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",78.39,45,,62.71,,,0,"percent of total billed charges","45% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.2,100,,,,,0,"fee schedule","100% CMS fee schedule",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",113.23,65,,90.58,,,0,"percent of total billed charges","65% of total billed charges",76.82,27,,61.46,,,0,"percent of total billed charges","27% of total billed charges",165.49,95,,132.39,,,0,"percent of total billed charges","95% of total billed charges",174.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",153.3,88,,122.64,,,0,"percent of total billed charges","88% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",76.82,174.2,
"D10W 500ML SOLN",2720002158,CDM,250,RC,,,Outpatient,,,174.2,87.1,,174.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",132.39,76,,105.91,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",125.42,72,,100.34,,,0,"percent of total billed charges","72% of total billed charges",130.65,75,,104.52,,,0,"percent of total billed charges","75% of total billed charges",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",125.42,72,,100.34,,,0,"percent of total billed charges","72% of total billed charges",104.52,60,,83.62,,,0,"percent of total billed charges","60% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",78.39,45,,62.71,,,0,"percent of total billed charges","45% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",174.2,100,,,,,0,"fee schedule","100% CMS fee schedule",174.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",113.23,65,,90.58,,,0,"percent of total billed charges","65% of total billed charges",76.82,27,,61.46,,,0,"percent of total billed charges","27% of total billed charges",165.49,95,,132.39,,,0,"percent of total billed charges","95% of total billed charges",174.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",153.3,88,,122.64,,,0,"percent of total billed charges","88% of total billed charges",156.78,90,,125.42,,,0,"percent of total billed charges","90% of total billed charges",76.82,174.2,
"NITRO 25MG/250ML INJ",2720002161,CDM,250,RC,,,Outpatient,,,89.3,44.65,,89.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.87,76,,54.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",64.3,72,,51.44,,,0,"percent of total billed charges","72% of total billed charges",66.98,75,,53.58,,,0,"percent of total billed charges","75% of total billed charges",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.3,72,,51.44,,,0,"percent of total billed charges","72% of total billed charges",53.58,60,,42.86,,,0,"percent of total billed charges","60% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",40.19,45,,32.15,,,0,"percent of total billed charges","45% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.3,100,,,,,0,"fee schedule","100% CMS fee schedule",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.05,65,,46.44,,,0,"percent of total billed charges","65% of total billed charges",39.38,27,,31.50,,,0,"percent of total billed charges","27% of total billed charges",84.84,95,,67.87,,,0,"percent of total billed charges","95% of total billed charges",89.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",78.58,88,,62.86,,,0,"percent of total billed charges","88% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",39.38,89.3,
"NITRO 25MG/250ML INJ",2720002162,CDM,250,RC,,,Outpatient,,,89.3,44.65,,89.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.87,76,,54.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",64.3,72,,51.44,,,0,"percent of total billed charges","72% of total billed charges",66.98,75,,53.58,,,0,"percent of total billed charges","75% of total billed charges",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",64.3,72,,51.44,,,0,"percent of total billed charges","72% of total billed charges",53.58,60,,42.86,,,0,"percent of total billed charges","60% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",40.19,45,,32.15,,,0,"percent of total billed charges","45% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.3,100,,,,,0,"fee schedule","100% CMS fee schedule",89.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.05,65,,46.44,,,0,"percent of total billed charges","65% of total billed charges",39.38,27,,31.50,,,0,"percent of total billed charges","27% of total billed charges",84.84,95,,67.87,,,0,"percent of total billed charges","95% of total billed charges",89.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",78.58,88,,62.86,,,0,"percent of total billed charges","88% of total billed charges",80.37,90,,64.30,,,0,"percent of total billed charges","90% of total billed charges",39.38,89.3,
"TRACE MTE 5 10ML INJ",2720002165,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"TRACE MTE 5 10ML INJ",2720002166,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"INDIGO CARMINE 5ML INJ",2720002169,CDM,250,RC,,,Outpatient,,,40.79,20.395,,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",30.59,75,,24.47,,,0,"percent of total billed charges","75% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",24.47,60,,19.58,,,0,"percent of total billed charges","60% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,14.39,,,0,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",17.99,40.79,
"INDIGO CARMINE 5ML INJ",2720002170,CDM,250,RC,,,Outpatient,,,40.79,20.395,,40.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",31,76,,24.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",30.59,75,,24.47,,,0,"percent of total billed charges","75% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.37,72,,23.50,,,0,"percent of total billed charges","72% of total billed charges",24.47,60,,19.58,,,0,"percent of total billed charges","60% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",18.36,45,,14.69,,,0,"percent of total billed charges","45% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% CMS fee schedule",40.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.51,65,,21.21,,,0,"percent of total billed charges","65% of total billed charges",17.99,27,,14.39,,,0,"percent of total billed charges","27% of total billed charges",38.75,95,,31.00,,,0,"percent of total billed charges","95% of total billed charges",40.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",35.9,88,,28.72,,,0,"percent of total billed charges","88% of total billed charges",36.71,90,,29.37,,,0,"percent of total billed charges","90% of total billed charges",17.99,40.79,
"NACL 50MEQ/20ML INJ",2720002177,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NACL 50MEQ/20ML INJ",2720002178,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"XYLOCAINE 1.5PCT 1ML INJ",2720002181,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"XYLOCAINE 1.5PCT 1ML INJ",2720002182,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"SENSORCAINE 0.5% 30ML",2720002185,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"SENSORCAINE 0.5% 30ML",2720002186,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"LANTUS INSULIN 100ML INJ",2720002189,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"LANTUS INSULIN 100ML INJ",2720002190,CDM,250,RC,,,Outpatient,,,56.23,28.115,,56.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.73,76,,34.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",42.17,75,,33.74,,,0,"percent of total billed charges","75% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.49,72,,32.39,,,0,"percent of total billed charges","72% of total billed charges",33.74,60,,26.99,,,0,"percent of total billed charges","60% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",25.3,45,,20.24,,,0,"percent of total billed charges","45% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% CMS fee schedule",56.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.55,65,,29.24,,,0,"percent of total billed charges","65% of total billed charges",24.8,27,,19.84,,,0,"percent of total billed charges","27% of total billed charges",53.42,95,,42.74,,,0,"percent of total billed charges","95% of total billed charges",56.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.48,88,,39.58,,,0,"percent of total billed charges","88% of total billed charges",50.61,90,,40.49,,,0,"percent of total billed charges","90% of total billed charges",24.8,56.23,
"THROMBINTOP .5000UNIT INJ",2720002193,CDM,250,RC,,,Outpatient,,,393.59,196.795,,393.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",299.13,76,,239.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",283.38,72,,226.70,,,0,"percent of total billed charges","72% of total billed charges",295.19,75,,236.15,,,0,"percent of total billed charges","75% of total billed charges",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",283.38,72,,226.70,,,0,"percent of total billed charges","72% of total billed charges",236.15,60,,188.92,,,0,"percent of total billed charges","60% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",177.12,45,,141.70,,,0,"percent of total billed charges","45% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",393.59,100,,,,,0,"fee schedule","100% CMS fee schedule",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",255.83,65,,204.66,,,0,"percent of total billed charges","65% of total billed charges",173.57,27,,138.86,,,0,"percent of total billed charges","27% of total billed charges",373.91,95,,299.13,,,0,"percent of total billed charges","95% of total billed charges",393.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",346.36,88,,277.09,,,0,"percent of total billed charges","88% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",173.57,393.59,
"THROMBINTOP .5000UNIT INJ",2720002194,CDM,250,RC,,,Outpatient,,,393.59,196.795,,393.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",299.13,76,,239.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",283.38,72,,226.70,,,0,"percent of total billed charges","72% of total billed charges",295.19,75,,236.15,,,0,"percent of total billed charges","75% of total billed charges",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",283.38,72,,226.70,,,0,"percent of total billed charges","72% of total billed charges",236.15,60,,188.92,,,0,"percent of total billed charges","60% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",177.12,45,,141.70,,,0,"percent of total billed charges","45% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",393.59,100,,,,,0,"fee schedule","100% CMS fee schedule",393.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",255.83,65,,204.66,,,0,"percent of total billed charges","65% of total billed charges",173.57,27,,138.86,,,0,"percent of total billed charges","27% of total billed charges",373.91,95,,299.13,,,0,"percent of total billed charges","95% of total billed charges",393.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",346.36,88,,277.09,,,0,"percent of total billed charges","88% of total billed charges",354.23,90,,283.38,,,0,"percent of total billed charges","90% of total billed charges",173.57,393.59,
"XYLOCAINE 5% 35GM OINT",2720002197,CDM,250,RC,,,Outpatient,,,292.16,146.08,,292.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",222.04,76,,177.63,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",210.36,72,,168.29,,,0,"percent of total billed charges","72% of total billed charges",219.12,75,,175.30,,,0,"percent of total billed charges","75% of total billed charges",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",210.36,72,,168.29,,,0,"percent of total billed charges","72% of total billed charges",175.3,60,,140.24,,,0,"percent of total billed charges","60% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",131.47,45,,105.18,,,0,"percent of total billed charges","45% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",292.16,100,,,,,0,"fee schedule","100% CMS fee schedule",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.9,65,,151.92,,,0,"percent of total billed charges","65% of total billed charges",128.84,27,,103.07,,,0,"percent of total billed charges","27% of total billed charges",277.55,95,,222.04,,,0,"percent of total billed charges","95% of total billed charges",292.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",257.1,88,,205.68,,,0,"percent of total billed charges","88% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",128.84,292.16,
"XYLOCAINE 5% 35GM OINT",2720002198,CDM,250,RC,,,Outpatient,,,292.16,146.08,,292.16,125,,,,,0,"fee schedule","125% of CMS fee schedule",222.04,76,,177.63,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",210.36,72,,168.29,,,0,"percent of total billed charges","72% of total billed charges",219.12,75,,175.30,,,0,"percent of total billed charges","75% of total billed charges",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",210.36,72,,168.29,,,0,"percent of total billed charges","72% of total billed charges",175.3,60,,140.24,,,0,"percent of total billed charges","60% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",131.47,45,,105.18,,,0,"percent of total billed charges","45% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",292.16,100,,,,,0,"fee schedule","100% CMS fee schedule",292.16,100,,,,,0,"fee schedule","100% of CMS fee schedule",189.9,65,,151.92,,,0,"percent of total billed charges","65% of total billed charges",128.84,27,,103.07,,,0,"percent of total billed charges","27% of total billed charges",277.55,95,,222.04,,,0,"percent of total billed charges","95% of total billed charges",292.16,75,,,,,0,"fee schedule","75% of CMS fee schedule",257.1,88,,205.68,,,0,"percent of total billed charges","88% of total billed charges",262.94,90,,210.35,,,0,"percent of total billed charges","90% of total billed charges",128.84,292.16,
"AMICAR 250MG INJ",2720002201,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"AMICAR 250MG INJ",2720002202,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"BACITRACN 50000U INJ",2720002205,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"BACITRACN 50000U INJ",2720002206,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"BREVIBLOC 10MG/ML INJ",2720002209,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"BREVIBLOC 10MG/ML INJ",2720002210,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"CALCIUM CHL 10% INJ",2720002213,CDM,250,RC,,,Outpatient,,,46.31,23.155,,46.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.2,76,,28.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",34.73,75,,27.78,,,0,"percent of total billed charges","75% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",27.79,60,,22.23,,,0,"percent of total billed charges","60% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.84,45,,16.67,,,0,"percent of total billed charges","45% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.1,65,,24.08,,,0,"percent of total billed charges","65% of total billed charges",20.42,27,,16.34,,,0,"percent of total billed charges","27% of total billed charges",43.99,95,,35.19,,,0,"percent of total billed charges","95% of total billed charges",46.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",40.75,88,,32.60,,,0,"percent of total billed charges","88% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.42,46.31,
"CALCIUM CHL 10% INJ",2720002214,CDM,250,RC,,,Outpatient,,,46.31,23.155,,46.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.2,76,,28.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",34.73,75,,27.78,,,0,"percent of total billed charges","75% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.34,72,,26.67,,,0,"percent of total billed charges","72% of total billed charges",27.79,60,,22.23,,,0,"percent of total billed charges","60% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.84,45,,16.67,,,0,"percent of total billed charges","45% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% CMS fee schedule",46.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.1,65,,24.08,,,0,"percent of total billed charges","65% of total billed charges",20.42,27,,16.34,,,0,"percent of total billed charges","27% of total billed charges",43.99,95,,35.19,,,0,"percent of total billed charges","95% of total billed charges",46.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",40.75,88,,32.60,,,0,"percent of total billed charges","88% of total billed charges",41.68,90,,33.34,,,0,"percent of total billed charges","90% of total billed charges",20.42,46.31,
"DEXTROSE 50% SYRINGE INJ",2720002217,CDM,250,RC,,,Outpatient,,,52.92,26.46,,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",39.69,75,,31.75,,,0,"percent of total billed charges","75% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",31.75,60,,25.40,,,0,"percent of total billed charges","60% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,18.67,,,0,"percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,37.26,,,0,"percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.34,52.92,
"DEXTROSE 50% SYRINGE INJ",2720002218,CDM,250,RC,,,Outpatient,,,52.92,26.46,,52.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",40.22,76,,32.18,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",39.69,75,,31.75,,,0,"percent of total billed charges","75% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.1,72,,30.48,,,0,"percent of total billed charges","72% of total billed charges",31.75,60,,25.40,,,0,"percent of total billed charges","60% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.81,45,,19.05,,,0,"percent of total billed charges","45% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% CMS fee schedule",52.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.4,65,,27.52,,,0,"percent of total billed charges","65% of total billed charges",23.34,27,,18.67,,,0,"percent of total billed charges","27% of total billed charges",50.27,95,,40.22,,,0,"percent of total billed charges","95% of total billed charges",52.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",46.57,88,,37.26,,,0,"percent of total billed charges","88% of total billed charges",47.63,90,,38.10,,,0,"percent of total billed charges","90% of total billed charges",23.34,52.92,
"DOPRAM 20MG/ML INJ",2720002221,CDM,250,RC,,,Outpatient,,,302.09,151.045,,302.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",229.59,76,,183.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",226.57,75,,181.26,,,0,"percent of total billed charges","75% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",181.25,60,,145.00,,,0,"percent of total billed charges","60% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",135.94,45,,108.75,,,0,"percent of total billed charges","45% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",196.36,65,,157.09,,,0,"percent of total billed charges","65% of total billed charges",133.22,27,,106.58,,,0,"percent of total billed charges","27% of total billed charges",286.99,95,,229.59,,,0,"percent of total billed charges","95% of total billed charges",302.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",265.84,88,,212.67,,,0,"percent of total billed charges","88% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",133.22,302.09,
"DOPRAM 20MG/ML INJ",2720002222,CDM,250,RC,,,Outpatient,,,302.09,151.045,,302.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",229.59,76,,183.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",226.57,75,,181.26,,,0,"percent of total billed charges","75% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",181.25,60,,145.00,,,0,"percent of total billed charges","60% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",135.94,45,,108.75,,,0,"percent of total billed charges","45% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",196.36,65,,157.09,,,0,"percent of total billed charges","65% of total billed charges",133.22,27,,106.58,,,0,"percent of total billed charges","27% of total billed charges",286.99,95,,229.59,,,0,"percent of total billed charges","95% of total billed charges",302.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",265.84,88,,212.67,,,0,"percent of total billed charges","88% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",133.22,302.09,
"FLAGYL IV 500MG INJ",2720002225,CDM,250,RC,,,Outpatient,,,175.3,87.65,,175.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",133.23,76,,106.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",126.22,72,,100.98,,,0,"percent of total billed charges","72% of total billed charges",131.48,75,,105.18,,,0,"percent of total billed charges","75% of total billed charges",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.22,72,,100.98,,,0,"percent of total billed charges","72% of total billed charges",105.18,60,,84.14,,,0,"percent of total billed charges","60% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",78.89,45,,63.11,,,0,"percent of total billed charges","45% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",175.3,100,,,,,0,"fee schedule","100% CMS fee schedule",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",113.95,65,,91.16,,,0,"percent of total billed charges","65% of total billed charges",77.31,27,,61.85,,,0,"percent of total billed charges","27% of total billed charges",166.54,95,,133.23,,,0,"percent of total billed charges","95% of total billed charges",175.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",154.26,88,,123.41,,,0,"percent of total billed charges","88% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",77.31,175.3,
"FLAGYL IV 500MG INJ",2720002226,CDM,250,RC,,,Outpatient,,,175.3,87.65,,175.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",133.23,76,,106.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",126.22,72,,100.98,,,0,"percent of total billed charges","72% of total billed charges",131.48,75,,105.18,,,0,"percent of total billed charges","75% of total billed charges",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",126.22,72,,100.98,,,0,"percent of total billed charges","72% of total billed charges",105.18,60,,84.14,,,0,"percent of total billed charges","60% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",78.89,45,,63.11,,,0,"percent of total billed charges","45% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",175.3,100,,,,,0,"fee schedule","100% CMS fee schedule",175.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",113.95,65,,91.16,,,0,"percent of total billed charges","65% of total billed charges",77.31,27,,61.85,,,0,"percent of total billed charges","27% of total billed charges",166.54,95,,133.23,,,0,"percent of total billed charges","95% of total billed charges",175.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",154.26,88,,123.41,,,0,"percent of total billed charges","88% of total billed charges",157.77,90,,126.22,,,0,"percent of total billed charges","90% of total billed charges",77.31,175.3,
"FOLVITE 5MG INJ 1ML INJ",2720002229,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"FOLVITE 5MG INJ 1ML INJ",2720002230,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"HESPAN INJ",2720002233,CDM,250,RC,,,Outpatient,,,293.27,146.635,,293.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",222.89,76,,178.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",211.15,72,,168.92,,,0,"percent of total billed charges","72% of total billed charges",219.95,75,,175.96,,,0,"percent of total billed charges","75% of total billed charges",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.15,72,,168.92,,,0,"percent of total billed charges","72% of total billed charges",175.96,60,,140.77,,,0,"percent of total billed charges","60% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",131.97,45,,105.58,,,0,"percent of total billed charges","45% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",293.27,100,,,,,0,"fee schedule","100% CMS fee schedule",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.63,65,,152.50,,,0,"percent of total billed charges","65% of total billed charges",129.33,27,,103.46,,,0,"percent of total billed charges","27% of total billed charges",278.61,95,,222.89,,,0,"percent of total billed charges","95% of total billed charges",293.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",258.08,88,,206.46,,,0,"percent of total billed charges","88% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",129.33,293.27,
"HESPAN INJ",2720002234,CDM,250,RC,,,Outpatient,,,293.27,146.635,,293.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",222.89,76,,178.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",211.15,72,,168.92,,,0,"percent of total billed charges","72% of total billed charges",219.95,75,,175.96,,,0,"percent of total billed charges","75% of total billed charges",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",211.15,72,,168.92,,,0,"percent of total billed charges","72% of total billed charges",175.96,60,,140.77,,,0,"percent of total billed charges","60% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",131.97,45,,105.58,,,0,"percent of total billed charges","45% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",293.27,100,,,,,0,"fee schedule","100% CMS fee schedule",293.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",190.63,65,,152.50,,,0,"percent of total billed charges","65% of total billed charges",129.33,27,,103.46,,,0,"percent of total billed charges","27% of total billed charges",278.61,95,,222.89,,,0,"percent of total billed charges","95% of total billed charges",293.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",258.08,88,,206.46,,,0,"percent of total billed charges","88% of total billed charges",263.94,90,,211.15,,,0,"percent of total billed charges","90% of total billed charges",129.33,293.27,
"ISOPTIN 5MG/2ML AMP INJ",2720002237,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"ISOPTIN 5MG/2ML AMP INJ",2720002238,CDM,250,RC,,,Outpatient,,,37.49,18.745,,37.49,125,,,,,0,"fee schedule","125% of CMS fee schedule",28.49,76,,22.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",28.12,75,,22.50,,,0,"percent of total billed charges","75% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.99,72,,21.59,,,0,"percent of total billed charges","72% of total billed charges",22.49,60,,17.99,,,0,"percent of total billed charges","60% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.87,45,,13.50,,,0,"percent of total billed charges","45% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% CMS fee schedule",37.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.37,65,,19.50,,,0,"percent of total billed charges","65% of total billed charges",16.53,27,,13.22,,,0,"percent of total billed charges","27% of total billed charges",35.62,95,,28.50,,,0,"percent of total billed charges","95% of total billed charges",37.49,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.99,88,,26.39,,,0,"percent of total billed charges","88% of total billed charges",33.74,90,,26.99,,,0,"percent of total billed charges","90% of total billed charges",16.53,37.49,
"IMITREX 6MG INJ",2720002241,CDM,250,RC,J3030,HCPCS,Outpatient,,,280.04,140.02,U8,280.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",212.83,76,,170.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",84.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",84.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",24.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",126.02,45,,100.82,,,0,"percent of total billed charges","45% of total billed charges",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.04,100,,,,,0,"fee schedule","100% CMS fee schedule",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",182.03,65,,145.62,,,0,"percent of total billed charges","65% of total billed charges",123.5,27,,98.80,,,0,"percent of total billed charges","27% of total billed charges",266.04,95,,212.83,,,0,"percent of total billed charges","95% of total billed charges",280.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",246.44,88,,197.15,,,0,"percent of total billed charges","88% of total billed charges",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",24.19,280.04,
"IMITREX 6MG INJ",2720002242,CDM,250,RC,J3030,HCPCS,Outpatient,,,280.04,140.02,U8,280.04,125,,,,,0,"fee schedule","125% of CMS fee schedule",212.83,76,,170.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",84.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",84.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",84.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",24.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",126.02,45,,100.82,,,0,"percent of total billed charges","45% of total billed charges",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",280.04,100,,,,,0,"fee schedule","100% CMS fee schedule",280.04,100,,,,,0,"fee schedule","100% of CMS fee schedule",182.03,65,,145.62,,,0,"percent of total billed charges","65% of total billed charges",123.5,27,,98.80,,,0,"percent of total billed charges","27% of total billed charges",266.04,95,,212.83,,,0,"percent of total billed charges","95% of total billed charges",280.04,75,,,,,0,"fee schedule","75% of CMS fee schedule",246.44,88,,197.15,,,0,"percent of total billed charges","88% of total billed charges",252.04,90,,201.63,,,0,"percent of total billed charges","90% of total billed charges",24.19,280.04,
"ISUPREL 1CC INJ",2720002245,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"ISUPREL 1CC INJ",2720002246,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"MVI12 TWO 5ML INJ",2720002249,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"MVI12 TWO 5ML INJ",2720002250,CDM,250,RC,,,Outpatient,,,31.97,15.985,,31.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",24.3,76,,19.44,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",23.98,75,,19.18,,,0,"percent of total billed charges","75% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.02,72,,18.42,,,0,"percent of total billed charges","72% of total billed charges",19.18,60,,15.34,,,0,"percent of total billed charges","60% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.39,45,,11.51,,,0,"percent of total billed charges","45% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% CMS fee schedule",31.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.78,65,,16.62,,,0,"percent of total billed charges","65% of total billed charges",14.1,27,,11.28,,,0,"percent of total billed charges","27% of total billed charges",30.37,95,,24.30,,,0,"percent of total billed charges","95% of total billed charges",31.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",28.13,88,,22.50,,,0,"percent of total billed charges","88% of total billed charges",28.77,90,,23.02,,,0,"percent of total billed charges","90% of total billed charges",14.1,31.97,
"MARCAINE .25% / 30ML INJ",2720002253,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"MARCAINE .25% / 30ML INJ",2720002254,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"MARCAIN .25% /  50 ML INJ",2720002257,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"MARCAIN .25% /  50 ML INJ",2720002258,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"MARCAINE 5% & EPI INJ",2720002261,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"MARCAINE 5% & EPI INJ",2720002262,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"MARCAINE .75% PLAIN INJ",2720002265,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"MARCAINE .75% PLAIN INJ",2720002266,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"ROMAZICON 1MG/10ML",2720002269,CDM,250,RC,,,Outpatient,,,164.27,82.135,,164.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.85,76,,99.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",123.2,75,,98.56,,,0,"percent of total billed charges","75% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",98.56,60,,78.85,,,0,"percent of total billed charges","60% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",73.92,45,,59.14,,,0,"percent of total billed charges","45% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.78,65,,85.42,,,0,"percent of total billed charges","65% of total billed charges",72.44,27,,57.95,,,0,"percent of total billed charges","27% of total billed charges",156.06,95,,124.85,,,0,"percent of total billed charges","95% of total billed charges",164.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",144.56,88,,115.65,,,0,"percent of total billed charges","88% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",72.44,164.27,
"ROMAZICON 1MG/10ML",2720002270,CDM,250,RC,,,Outpatient,,,164.27,82.135,,164.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",124.85,76,,99.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",123.2,75,,98.56,,,0,"percent of total billed charges","75% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",118.27,72,,94.62,,,0,"percent of total billed charges","72% of total billed charges",98.56,60,,78.85,,,0,"percent of total billed charges","60% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",73.92,45,,59.14,,,0,"percent of total billed charges","45% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% CMS fee schedule",164.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",106.78,65,,85.42,,,0,"percent of total billed charges","65% of total billed charges",72.44,27,,57.95,,,0,"percent of total billed charges","27% of total billed charges",156.06,95,,124.85,,,0,"percent of total billed charges","95% of total billed charges",164.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",144.56,88,,115.65,,,0,"percent of total billed charges","88% of total billed charges",147.84,90,,118.27,,,0,"percent of total billed charges","90% of total billed charges",72.44,164.27,
"NEOSYNEPHRINE 1% AMP",2720002273,CDM,250,RC,J2371,HCPCS,Outpatient,,,15.44,7.72,U8,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,31.68,31.68,31.68,"1 through 10","percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"NEOSYNEPHRINE 1% AMP",2720002274,CDM,250,RC,J2370,HCPCS,Outpatient,,,15.44,7.72,U8,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,9.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.12,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",3.12,350,,,,,0,"fee schedule","350% of BCBS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.12,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.89,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.59,88,,10.87,,,0,"percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",0.89,15.44,
"NEUT 5ML INJ",2720002277,CDM,250,RC,J3490,HCPCS,Outpatient,,,26.46,13.23,U8,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"NEUT 5ML INJ",2720002278,CDM,250,RC,J3490,HCPCS,Outpatient,,,26.46,13.23,U8,26.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",20.11,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",19.85,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.05,72,,15.24,,,0,"percent of total billed charges","72% of total billed charges",15.88,60,,12.70,,,0,"percent of total billed charges","60% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.91,45,,9.53,,,0,"percent of total billed charges","45% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% CMS fee schedule",26.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.2,65,,13.76,,,0,"percent of total billed charges","65% of total billed charges",11.67,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",25.14,95,,20.11,,,0,"percent of total billed charges","95% of total billed charges",26.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",23.28,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",23.81,90,,19.05,,,0,"percent of total billed charges","90% of total billed charges",11.67,26.46,
"NIPRID 50MG 5CC VIAL INJ",2720002281,CDM,250,RC,,,Outpatient,,,238.14,119.07,,238.14,125,,,,,0,"fee schedule","125% of CMS fee schedule",180.99,76,,144.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",171.46,72,,137.17,,,0,"percent of total billed charges","72% of total billed charges",178.61,75,,142.89,,,0,"percent of total billed charges","75% of total billed charges",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.46,72,,137.17,,,0,"percent of total billed charges","72% of total billed charges",142.88,60,,114.30,,,0,"percent of total billed charges","60% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",107.16,45,,85.73,,,0,"percent of total billed charges","45% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",238.14,100,,,,,0,"fee schedule","100% CMS fee schedule",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",154.79,65,,123.83,,,0,"percent of total billed charges","65% of total billed charges",105.02,27,,84.02,,,0,"percent of total billed charges","27% of total billed charges",226.23,95,,180.98,,,0,"percent of total billed charges","95% of total billed charges",238.14,75,,,,,0,"fee schedule","75% of CMS fee schedule",209.56,88,,167.65,,,0,"percent of total billed charges","88% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",105.02,238.14,
"NIPRID 50MG 5CC VIAL INJ",2720002282,CDM,250,RC,,,Outpatient,,,238.14,119.07,,238.14,125,,,,,0,"fee schedule","125% of CMS fee schedule",180.99,76,,144.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",171.46,72,,137.17,,,0,"percent of total billed charges","72% of total billed charges",178.61,75,,142.89,,,0,"percent of total billed charges","75% of total billed charges",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",171.46,72,,137.17,,,0,"percent of total billed charges","72% of total billed charges",142.88,60,,114.30,,,0,"percent of total billed charges","60% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",107.16,45,,85.73,,,0,"percent of total billed charges","45% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",238.14,100,,,,,0,"fee schedule","100% CMS fee schedule",238.14,100,,,,,0,"fee schedule","100% of CMS fee schedule",154.79,65,,123.83,,,0,"percent of total billed charges","65% of total billed charges",105.02,27,,84.02,,,0,"percent of total billed charges","27% of total billed charges",226.23,95,,180.98,,,0,"percent of total billed charges","95% of total billed charges",238.14,75,,,,,0,"fee schedule","75% of CMS fee schedule",209.56,88,,167.65,,,0,"percent of total billed charges","88% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",105.02,238.14,
"NORCURON 10MG INJ",2720002285,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"NORCURON 10MG INJ",2720002286,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"PAVULON 10MG/5ML INJ",2720002289,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"PAVULON 10MG/5ML INJ",2720002290,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"PITRESSIN 20 UNITS INJ",2720002293,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"PITRESSIN 20 UNITS INJ",2720002294,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"POLYMYXIN B 500000 INJ",2720002297,CDM,250,RC,,,Outpatient,,,69.46,34.73,,69.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",52.79,76,,42.23,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",50.01,72,,40.01,,,0,"percent of total billed charges","72% of total billed charges",52.1,75,,41.68,,,0,"percent of total billed charges","75% of total billed charges",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.01,72,,40.01,,,0,"percent of total billed charges","72% of total billed charges",41.68,60,,33.34,,,0,"percent of total billed charges","60% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",31.26,45,,25.01,,,0,"percent of total billed charges","45% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.46,100,,,,,0,"fee schedule","100% CMS fee schedule",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.15,65,,36.12,,,0,"percent of total billed charges","65% of total billed charges",30.63,27,,24.50,,,0,"percent of total billed charges","27% of total billed charges",65.99,95,,52.79,,,0,"percent of total billed charges","95% of total billed charges",69.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",61.12,88,,48.90,,,0,"percent of total billed charges","88% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",30.63,69.46,
"POLYMYXIN B 500000 INJ",2720002298,CDM,250,RC,,,Outpatient,,,69.46,34.73,,69.46,125,,,,,0,"fee schedule","125% of CMS fee schedule",52.79,76,,42.23,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",50.01,72,,40.01,,,0,"percent of total billed charges","72% of total billed charges",52.1,75,,41.68,,,0,"percent of total billed charges","75% of total billed charges",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.01,72,,40.01,,,0,"percent of total billed charges","72% of total billed charges",41.68,60,,33.34,,,0,"percent of total billed charges","60% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",31.26,45,,25.01,,,0,"percent of total billed charges","45% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",69.46,100,,,,,0,"fee schedule","100% CMS fee schedule",69.46,100,,,,,0,"fee schedule","100% of CMS fee schedule",45.15,65,,36.12,,,0,"percent of total billed charges","65% of total billed charges",30.63,27,,24.50,,,0,"percent of total billed charges","27% of total billed charges",65.99,95,,52.79,,,0,"percent of total billed charges","95% of total billed charges",69.46,75,,,,,0,"fee schedule","75% of CMS fee schedule",61.12,88,,48.90,,,0,"percent of total billed charges","88% of total billed charges",62.51,90,,50.01,,,0,"percent of total billed charges","90% of total billed charges",30.63,69.46,
"POTASSIUM ACETATE 40MEQ INJ",2720002301,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"POTASSIUM ACETATE 40MEQ INJ",2720002302,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"SOD BICARB SY 50CC INJ",2720002305,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"SOD BICARB SY 50CC INJ",2720002306,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"SYNTHROID INJ 200MCG",2720002309,CDM,250,RC,,,Outpatient,,,109.15,54.575,,109.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.95,76,,66.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",78.59,72,,62.87,,,0,"percent of total billed charges","72% of total billed charges",81.86,75,,65.49,,,0,"percent of total billed charges","75% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.59,72,,62.87,,,0,"percent of total billed charges","72% of total billed charges",65.49,60,,52.39,,,0,"percent of total billed charges","60% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",49.12,45,,39.30,,,0,"percent of total billed charges","45% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.95,65,,56.76,,,0,"percent of total billed charges","65% of total billed charges",48.14,27,,38.51,,,0,"percent of total billed charges","27% of total billed charges",103.69,95,,82.95,,,0,"percent of total billed charges","95% of total billed charges",109.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",96.05,88,,76.84,,,0,"percent of total billed charges","88% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",48.14,109.15,
"SYNTHROID INJ 200MCG",2720002310,CDM,250,RC,,,Outpatient,,,109.15,54.575,,109.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",82.95,76,,66.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",78.59,72,,62.87,,,0,"percent of total billed charges","72% of total billed charges",81.86,75,,65.49,,,0,"percent of total billed charges","75% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.59,72,,62.87,,,0,"percent of total billed charges","72% of total billed charges",65.49,60,,52.39,,,0,"percent of total billed charges","60% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",49.12,45,,39.30,,,0,"percent of total billed charges","45% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% CMS fee schedule",109.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",70.95,65,,56.76,,,0,"percent of total billed charges","65% of total billed charges",48.14,27,,38.51,,,0,"percent of total billed charges","27% of total billed charges",103.69,95,,82.95,,,0,"percent of total billed charges","95% of total billed charges",109.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",96.05,88,,76.84,,,0,"percent of total billed charges","88% of total billed charges",98.24,90,,78.59,,,0,"percent of total billed charges","90% of total billed charges",48.14,109.15,
"LABETALOL INJ 5MG/ML INJ",2720002313,CDM,250,RC,J1920,HCPCS,Outpatient,,,38.59,19.295,TB,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,17.99,16.00,19.97,"1 through 10","percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"LABETALOL INJ 5MG/ML INJ",2720002314,CDM,250,RC,J1920,HCPCS,Outpatient,,,38.59,19.295,U8,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,17.99,16.00,19.97,"1 through 10","percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"TRIDIL MAINT 50MG/10ML INJ",2720002317,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"TRIDIL MAINT 50MG/10ML INJ",2720002318,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"XYLOCAINE 1% 30ML INJ",2720002321,CDM,250,RC,J2003,HCPCS,Outpatient,,,15.44,7.72,U8,15.44,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.73,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.58,75,,9.26,,,0,"percent of total billed charges","75% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.26,60,,7.41,,,0,"percent of total billed charges","60% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% CMS fee schedule",15.44,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",14.67,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.44,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",13.59,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",13.9,90,,11.12,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.44,
"XYLOCAINE 100MG/5CC INJ",2720002325,CDM,250,RC,J2003,HCPCS,Outpatient,,,22.05,11.025,U8,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",19.4,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"XYLOCAINE 100MG/5CC INJ",2720002326,CDM,250,RC,J2003,HCPCS,Outpatient,,,22.05,11.025,U8,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",19.4,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"XYLOCAINE 1% ADD CC INJ",2720002329,CDM,250,RC,J2003,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",5.83,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"XYLOCAINE 1% ADD CC INJ",2720002330,CDM,250,RC,J2003,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,8.21,1.65,717.90,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,6.11,4.89,15.73,18,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,14.34,14.34,14.34,"1 through 10","fee schedule","75% of CMS fee schedule",5.83,88,,12.95,9.29,15.28,"1 through 10","percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"KETAMINE 500MG/5ML INJ",2720002333,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"KETAMINE 500MG/5ML INJ",2720002334,CDM,250,RC,,,Outpatient,,,55.13,27.565,,55.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.9,76,,33.52,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",41.35,75,,33.08,,,0,"percent of total billed charges","75% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,72,,31.75,,,0,"percent of total billed charges","72% of total billed charges",33.08,60,,26.46,,,0,"percent of total billed charges","60% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.81,45,,19.85,,,0,"percent of total billed charges","45% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% CMS fee schedule",55.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.83,65,,28.66,,,0,"percent of total billed charges","65% of total billed charges",24.31,27,,19.45,,,0,"percent of total billed charges","27% of total billed charges",52.37,95,,41.90,,,0,"percent of total billed charges","95% of total billed charges",55.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",48.51,88,,38.81,,,0,"percent of total billed charges","88% of total billed charges",49.62,90,,39.70,,,0,"percent of total billed charges","90% of total billed charges",24.31,55.13,
"LOPRESSOR 5MG INJ",2720002337,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LOPRESSOR 5MG INJ",2720002338,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"ALFENTA 2ML INJ",2720002341,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"ALFENTA 2ML INJ",2720002342,CDM,250,RC,,,Outpatient,,,25.36,12.68,,25.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",19.27,76,,15.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",19.02,75,,15.22,,,0,"percent of total billed charges","75% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.26,72,,14.61,,,0,"percent of total billed charges","72% of total billed charges",15.22,60,,12.18,,,0,"percent of total billed charges","60% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.41,45,,9.13,,,0,"percent of total billed charges","45% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% CMS fee schedule",25.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.48,65,,13.18,,,0,"percent of total billed charges","65% of total billed charges",11.18,27,,8.94,,,0,"percent of total billed charges","27% of total billed charges",24.09,95,,19.27,,,0,"percent of total billed charges","95% of total billed charges",25.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",22.32,88,,17.86,,,0,"percent of total billed charges","88% of total billed charges",22.82,90,,18.26,,,0,"percent of total billed charges","90% of total billed charges",11.18,25.36,
"BSS 30ML INJ",2720002345,CDM,250,RC,,,Outpatient,,,79.38,39.69,,79.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",60.33,76,,48.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.15,72,,45.72,,,0,"percent of total billed charges","72% of total billed charges",59.54,75,,47.63,,,0,"percent of total billed charges","75% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.15,72,,45.72,,,0,"percent of total billed charges","72% of total billed charges",47.63,60,,38.10,,,0,"percent of total billed charges","60% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",35.72,45,,28.58,,,0,"percent of total billed charges","45% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,65,,41.28,,,0,"percent of total billed charges","65% of total billed charges",35.01,27,,28.01,,,0,"percent of total billed charges","27% of total billed charges",75.41,95,,60.33,,,0,"percent of total billed charges","95% of total billed charges",79.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",69.85,88,,55.88,,,0,"percent of total billed charges","88% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",35.01,79.38,
"BSS 30ML INJ",2720002346,CDM,250,RC,,,Outpatient,,,79.38,39.69,,79.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",60.33,76,,48.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.15,72,,45.72,,,0,"percent of total billed charges","72% of total billed charges",59.54,75,,47.63,,,0,"percent of total billed charges","75% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.15,72,,45.72,,,0,"percent of total billed charges","72% of total billed charges",47.63,60,,38.10,,,0,"percent of total billed charges","60% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",35.72,45,,28.58,,,0,"percent of total billed charges","45% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% CMS fee schedule",79.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,65,,41.28,,,0,"percent of total billed charges","65% of total billed charges",35.01,27,,28.01,,,0,"percent of total billed charges","27% of total billed charges",75.41,95,,60.33,,,0,"percent of total billed charges","95% of total billed charges",79.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",69.85,88,,55.88,,,0,"percent of total billed charges","88% of total billed charges",71.44,90,,57.15,,,0,"percent of total billed charges","90% of total billed charges",35.01,79.38,
"SODIUM CHLOR 9% 3ML INJ",2720002349,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SODIUM CHLOR 9% 3ML INJ",2720002350,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"SOD BICARB 4.2% PEDI INJ",2720002353,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"SOD BICARB 4.2% PEDI INJ",2720002354,CDM,250,RC,,,Outpatient,,,33.08,16.54,,33.08,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.14,76,,20.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",24.81,75,,19.85,,,0,"percent of total billed charges","75% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.82,72,,19.06,,,0,"percent of total billed charges","72% of total billed charges",19.85,60,,15.88,,,0,"percent of total billed charges","60% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.89,45,,11.91,,,0,"percent of total billed charges","45% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% CMS fee schedule",33.08,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.5,65,,17.20,,,0,"percent of total billed charges","65% of total billed charges",14.59,27,,11.67,,,0,"percent of total billed charges","27% of total billed charges",31.43,95,,25.14,,,0,"percent of total billed charges","95% of total billed charges",33.08,75,,,,,0,"fee schedule","75% of CMS fee schedule",29.11,88,,23.29,,,0,"percent of total billed charges","88% of total billed charges",29.77,90,,23.82,,,0,"percent of total billed charges","90% of total billed charges",14.59,33.08,
"DEXTROSE 25% SYG10ML INJ",2720002357,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"DEXTROSE 25% SYG10ML INJ",2720002358,CDM,250,RC,,,Outpatient,,,29.77,14.885,,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,18.10,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",22.33,75,,17.86,,,0,"percent of total billed charges","75% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.43,72,,17.14,,,0,"percent of total billed charges","72% of total billed charges",17.86,60,,14.29,,,0,"percent of total billed charges","60% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,10.50,,,0,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,20.96,,,0,"percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",13.13,29.77,
"ENLON INJ 10MG/ML INJ",2720002361,CDM,250,RC,,,Outpatient,,,228.22,114.11,,228.22,125,,,,,0,"fee schedule","125% of CMS fee schedule",173.45,76,,138.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",164.32,72,,131.46,,,0,"percent of total billed charges","72% of total billed charges",171.17,75,,136.94,,,0,"percent of total billed charges","75% of total billed charges",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.32,72,,131.46,,,0,"percent of total billed charges","72% of total billed charges",136.93,60,,109.54,,,0,"percent of total billed charges","60% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",102.7,45,,82.16,,,0,"percent of total billed charges","45% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",228.22,100,,,,,0,"fee schedule","100% CMS fee schedule",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",148.34,65,,118.67,,,0,"percent of total billed charges","65% of total billed charges",100.65,27,,80.52,,,0,"percent of total billed charges","27% of total billed charges",216.81,95,,173.45,,,0,"percent of total billed charges","95% of total billed charges",228.22,75,,,,,0,"fee schedule","75% of CMS fee schedule",200.83,88,,160.66,,,0,"percent of total billed charges","88% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",100.65,228.22,
"ENLON INJ 10MG/ML INJ",2720002362,CDM,250,RC,,,Outpatient,,,228.22,114.11,,228.22,125,,,,,0,"fee schedule","125% of CMS fee schedule",173.45,76,,138.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",164.32,72,,131.46,,,0,"percent of total billed charges","72% of total billed charges",171.17,75,,136.94,,,0,"percent of total billed charges","75% of total billed charges",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.32,72,,131.46,,,0,"percent of total billed charges","72% of total billed charges",136.93,60,,109.54,,,0,"percent of total billed charges","60% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",102.7,45,,82.16,,,0,"percent of total billed charges","45% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",228.22,100,,,,,0,"fee schedule","100% CMS fee schedule",228.22,100,,,,,0,"fee schedule","100% of CMS fee schedule",148.34,65,,118.67,,,0,"percent of total billed charges","65% of total billed charges",100.65,27,,80.52,,,0,"percent of total billed charges","27% of total billed charges",216.81,95,,173.45,,,0,"percent of total billed charges","95% of total billed charges",228.22,75,,,,,0,"fee schedule","75% of CMS fee schedule",200.83,88,,160.66,,,0,"percent of total billed charges","88% of total billed charges",205.4,90,,164.32,,,0,"percent of total billed charges","90% of total billed charges",100.65,228.22,
"SODIUM ACETATE 40MEQ INJ",2720002365,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"SODIUM ACETATE 40MEQ INJ",2720002366,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"AMIDATE 2MG/M/INJ",2720002369,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"AMIDATE 2MG/M/INJ",2720002370,CDM,250,RC,,,Outpatient,,,61.74,30.87,,61.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.92,76,,37.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",46.31,75,,37.05,,,0,"percent of total billed charges","75% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.45,72,,35.56,,,0,"percent of total billed charges","72% of total billed charges",37.04,60,,29.63,,,0,"percent of total billed charges","60% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.78,45,,22.22,,,0,"percent of total billed charges","45% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% CMS fee schedule",61.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",40.13,65,,32.10,,,0,"percent of total billed charges","65% of total billed charges",27.23,27,,21.78,,,0,"percent of total billed charges","27% of total billed charges",58.65,95,,46.92,,,0,"percent of total billed charges","95% of total billed charges",61.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",54.33,88,,43.46,,,0,"percent of total billed charges","88% of total billed charges",55.57,90,,44.46,,,0,"percent of total billed charges","90% of total billed charges",27.23,61.74,
"DANTRIUM 20MG INJ",2720002373,CDM,250,RC,,,Outpatient,,,486.2,243.1,,486.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",369.51,76,,295.61,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",350.06,72,,280.05,,,0,"percent of total billed charges","72% of total billed charges",364.65,75,,291.72,,,0,"percent of total billed charges","75% of total billed charges",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",350.06,72,,280.05,,,0,"percent of total billed charges","72% of total billed charges",291.72,60,,233.38,,,0,"percent of total billed charges","60% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",218.79,45,,175.03,,,0,"percent of total billed charges","45% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",486.2,100,,,,,0,"fee schedule","100% CMS fee schedule",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",316.03,65,,252.82,,,0,"percent of total billed charges","65% of total billed charges",214.41,27,,171.53,,,0,"percent of total billed charges","27% of total billed charges",461.89,95,,369.51,,,0,"percent of total billed charges","95% of total billed charges",486.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",427.86,88,,342.29,,,0,"percent of total billed charges","88% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",214.41,486.2,
"DANTRIUM 20MG INJ",2720002374,CDM,250,RC,,,Outpatient,,,486.2,243.1,,486.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",369.51,76,,295.61,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",350.06,72,,280.05,,,0,"percent of total billed charges","72% of total billed charges",364.65,75,,291.72,,,0,"percent of total billed charges","75% of total billed charges",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",350.06,72,,280.05,,,0,"percent of total billed charges","72% of total billed charges",291.72,60,,233.38,,,0,"percent of total billed charges","60% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",218.79,45,,175.03,,,0,"percent of total billed charges","45% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",486.2,100,,,,,0,"fee schedule","100% CMS fee schedule",486.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",316.03,65,,252.82,,,0,"percent of total billed charges","65% of total billed charges",214.41,27,,171.53,,,0,"percent of total billed charges","27% of total billed charges",461.89,95,,369.51,,,0,"percent of total billed charges","95% of total billed charges",486.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",427.86,88,,342.29,,,0,"percent of total billed charges","88% of total billed charges",437.58,90,,350.06,,,0,"percent of total billed charges","90% of total billed charges",214.41,486.2,
"SODIUM PHOSPHATE 60MEQ INJ",2720002377,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"SODIUM PHOSPHATE 60MEQ INJ",2720002378,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"NS 1000W/KCL 20MEQ SOLN",2720002381,CDM,250,RC,J3480,HCPCS,Outpatient,,,68.36,34.18,U8,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.14,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.04,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",61.52,90,,43.06,43.06,43.06,"1 through 10","percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,1.74,0.93,24.44,"1 through 10","percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,22.02,22.02,22.02,"1 through 10","percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",0.04,68.36,
"NS 1000W/KCL 20MEQ SOLN",2720002382,CDM,250,RC,J3480,HCPCS,Outpatient,,,68.36,34.18,U8,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.14,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.04,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",61.52,90,,43.06,43.06,43.06,"1 through 10","percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,1.74,0.93,24.44,"1 through 10","percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,22.02,22.02,22.02,"1 through 10","percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",0.04,68.36,
"NS 1000W/KCL 40MEQ SOLN",2720002385,CDM,250,RC,J3480,HCPCS,Outpatient,,,68.36,34.18,U8,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.14,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.04,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",61.52,90,,43.06,43.06,43.06,"1 through 10","percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,1.74,0.93,24.44,"1 through 10","percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,22.02,22.02,22.02,"1 through 10","percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",0.04,68.36,
"NS 1000W/KCL 40MEQ SOLN",2720002386,CDM,250,RC,J3480,HCPCS,Outpatient,,,68.36,34.18,U8,68.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.95,76,,41.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.14,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.14,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.04,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",61.52,90,,43.06,43.06,43.06,"1 through 10","percent of total billed charges","90% of total billed charges",30.76,45,,24.61,,,0,"percent of total billed charges","45% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% CMS fee schedule",68.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",44.43,65,,35.54,,,0,"percent of total billed charges","65% of total billed charges",30.15,27,,1.74,0.93,24.44,"1 through 10","percent of total billed charges","27% of total billed charges",64.94,95,,51.95,,,0,"percent of total billed charges","95% of total billed charges",68.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",60.16,88,,22.02,22.02,22.02,"1 through 10","percent of total billed charges","88% of total billed charges",61.52,90,,49.22,,,0,"percent of total billed charges","90% of total billed charges",0.04,68.36,
"CALCIUM GLUC 0.465MEQ/ML INJ",2720002389,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"CALCIUM GLUC 0.465MEQ/ML INJ",2720002390,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"POT PHOSPHATE 4.4M/ML INJ",2720002393,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"POT PHOSPHATE 4.4M/ML INJ",2720002394,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"NIMBEX 2MG 1ML INJ",2720002397,CDM,250,RC,,,Outpatient,,,80.48,40.24,,80.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",61.16,76,,48.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",60.36,75,,48.29,,,0,"percent of total billed charges","75% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",48.29,60,,38.63,,,0,"percent of total billed charges","60% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",36.22,45,,28.98,,,0,"percent of total billed charges","45% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.31,65,,41.85,,,0,"percent of total billed charges","65% of total billed charges",35.49,27,,28.39,,,0,"percent of total billed charges","27% of total billed charges",76.46,95,,61.17,,,0,"percent of total billed charges","95% of total billed charges",80.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",70.82,88,,56.66,,,0,"percent of total billed charges","88% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",35.49,80.48,
"NIMBEX 2MG 1ML INJ",2720002398,CDM,250,RC,,,Outpatient,,,80.48,40.24,,80.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",61.16,76,,48.93,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",60.36,75,,48.29,,,0,"percent of total billed charges","75% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.95,72,,46.36,,,0,"percent of total billed charges","72% of total billed charges",48.29,60,,38.63,,,0,"percent of total billed charges","60% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",36.22,45,,28.98,,,0,"percent of total billed charges","45% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% CMS fee schedule",80.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",52.31,65,,41.85,,,0,"percent of total billed charges","65% of total billed charges",35.49,27,,28.39,,,0,"percent of total billed charges","27% of total billed charges",76.46,95,,61.17,,,0,"percent of total billed charges","95% of total billed charges",80.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",70.82,88,,56.66,,,0,"percent of total billed charges","88% of total billed charges",72.43,90,,57.94,,,0,"percent of total billed charges","90% of total billed charges",35.49,80.48,
"BUPIVACAINE 0.75%/DEX INJ",2720002401,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"BUPIVACAINE 0.75%/DEX INJ",2720002402,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"TENORMIN 0.5MG/ML 10",2720002405,CDM,250,RC,,,Outpatient,,,54.02,27.01,,54.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.06,76,,32.85,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.89,72,,31.11,,,0,"percent of total billed charges","72% of total billed charges",40.52,75,,32.42,,,0,"percent of total billed charges","75% of total billed charges",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.89,72,,31.11,,,0,"percent of total billed charges","72% of total billed charges",32.41,60,,25.93,,,0,"percent of total billed charges","60% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",24.31,45,,19.45,,,0,"percent of total billed charges","45% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.11,65,,28.09,,,0,"percent of total billed charges","65% of total billed charges",23.82,27,,19.06,,,0,"percent of total billed charges","27% of total billed charges",51.32,95,,41.06,,,0,"percent of total billed charges","95% of total billed charges",54.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",47.54,88,,38.03,,,0,"percent of total billed charges","88% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",23.82,54.02,
"TENORMIN 0.5MG/ML 10",2720002406,CDM,250,RC,,,Outpatient,,,54.02,27.01,,54.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.06,76,,32.85,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",38.89,72,,31.11,,,0,"percent of total billed charges","72% of total billed charges",40.52,75,,32.42,,,0,"percent of total billed charges","75% of total billed charges",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.89,72,,31.11,,,0,"percent of total billed charges","72% of total billed charges",32.41,60,,25.93,,,0,"percent of total billed charges","60% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",24.31,45,,19.45,,,0,"percent of total billed charges","45% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.11,65,,28.09,,,0,"percent of total billed charges","65% of total billed charges",23.82,27,,19.06,,,0,"percent of total billed charges","27% of total billed charges",51.32,95,,41.06,,,0,"percent of total billed charges","95% of total billed charges",54.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",47.54,88,,38.03,,,0,"percent of total billed charges","88% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",23.82,54.02,
"NEOSPORIN G.U. IRRIT INJ",2720002409,CDM,250,RC,,,Outpatient,,,124.58,62.29,,124.58,125,,,,,0,"fee schedule","125% of CMS fee schedule",94.68,76,,75.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",89.7,72,,71.76,,,0,"percent of total billed charges","72% of total billed charges",93.44,75,,74.75,,,0,"percent of total billed charges","75% of total billed charges",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.7,72,,71.76,,,0,"percent of total billed charges","72% of total billed charges",74.75,60,,59.80,,,0,"percent of total billed charges","60% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",56.06,45,,44.85,,,0,"percent of total billed charges","45% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.58,100,,,,,0,"fee schedule","100% CMS fee schedule",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.98,65,,64.78,,,0,"percent of total billed charges","65% of total billed charges",54.94,27,,43.95,,,0,"percent of total billed charges","27% of total billed charges",118.35,95,,94.68,,,0,"percent of total billed charges","95% of total billed charges",124.58,75,,,,,0,"fee schedule","75% of CMS fee schedule",109.63,88,,87.70,,,0,"percent of total billed charges","88% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",54.94,124.58,
"NEOSPORIN G.U. IRRIT INJ",2720002410,CDM,250,RC,,,Outpatient,,,124.58,62.29,,124.58,125,,,,,0,"fee schedule","125% of CMS fee schedule",94.68,76,,75.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",89.7,72,,71.76,,,0,"percent of total billed charges","72% of total billed charges",93.44,75,,74.75,,,0,"percent of total billed charges","75% of total billed charges",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",89.7,72,,71.76,,,0,"percent of total billed charges","72% of total billed charges",74.75,60,,59.80,,,0,"percent of total billed charges","60% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",56.06,45,,44.85,,,0,"percent of total billed charges","45% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.58,100,,,,,0,"fee schedule","100% CMS fee schedule",124.58,100,,,,,0,"fee schedule","100% of CMS fee schedule",80.98,65,,64.78,,,0,"percent of total billed charges","65% of total billed charges",54.94,27,,43.95,,,0,"percent of total billed charges","27% of total billed charges",118.35,95,,94.68,,,0,"percent of total billed charges","95% of total billed charges",124.58,75,,,,,0,"fee schedule","75% of CMS fee schedule",109.63,88,,87.70,,,0,"percent of total billed charges","88% of total billed charges",112.12,90,,89.70,,,0,"percent of total billed charges","90% of total billed charges",54.94,124.58,
"INTRALIPIDS 20% 250ML INJ",2720002413,CDM,250,RC,,,Outpatient,,,156.56,78.28,,156.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",118.99,76,,95.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",117.42,75,,93.94,,,0,"percent of total billed charges","75% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",93.94,60,,75.15,,,0,"percent of total billed charges","60% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",70.45,45,,56.36,,,0,"percent of total billed charges","45% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.76,65,,81.41,,,0,"percent of total billed charges","65% of total billed charges",69.04,27,,55.23,,,0,"percent of total billed charges","27% of total billed charges",148.73,95,,118.98,,,0,"percent of total billed charges","95% of total billed charges",156.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",137.77,88,,110.22,,,0,"percent of total billed charges","88% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",69.04,156.56,
"INTRALIPIDS 20% 250ML INJ",2720002414,CDM,250,RC,,,Outpatient,,,156.56,78.28,,156.56,125,,,,,0,"fee schedule","125% of CMS fee schedule",118.99,76,,95.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",117.42,75,,93.94,,,0,"percent of total billed charges","75% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",112.72,72,,90.18,,,0,"percent of total billed charges","72% of total billed charges",93.94,60,,75.15,,,0,"percent of total billed charges","60% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",70.45,45,,56.36,,,0,"percent of total billed charges","45% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% CMS fee schedule",156.56,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.76,65,,81.41,,,0,"percent of total billed charges","65% of total billed charges",69.04,27,,55.23,,,0,"percent of total billed charges","27% of total billed charges",148.73,95,,118.98,,,0,"percent of total billed charges","95% of total billed charges",156.56,75,,,,,0,"fee schedule","75% of CMS fee schedule",137.77,88,,110.22,,,0,"percent of total billed charges","88% of total billed charges",140.9,90,,112.72,,,0,"percent of total billed charges","90% of total billed charges",69.04,156.56,
"HEPARIN NS 2U/ML 500ML SOLN",2720002417,CDM,250,RC,,,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"HEPARIN NS 2U/ML 500ML SOLN",2720002418,CDM,250,RC,J1644,HCPCS,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",0.19,39.69,
"PENICILLIN 3MMU/50ML INJ",2720002421,CDM,250,RC,J2540,HCPCS,Outpatient,,,191.84,95.92,U8,191.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",145.8,76,,116.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.41,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",4.41,350,,,,,0,"fee schedule","350% of BCBS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.26,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",86.33,45,,69.06,,,0,"percent of total billed charges","45% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.7,65,,99.76,,,0,"percent of total billed charges","65% of total billed charges",84.6,27,,39.39,39.39,39.39,"1 through 10","percent of total billed charges","27% of total billed charges",182.25,95,,145.80,,,0,"percent of total billed charges","95% of total billed charges",191.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",168.82,88,,135.06,,,0,"percent of total billed charges","88% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",1.26,191.84,
"PENICILLIN 3MMU/50ML INJ",2720002422,CDM,250,RC,J2540,HCPCS,Outpatient,,,191.84,95.92,U8,191.84,125,,,,,0,"fee schedule","125% of CMS fee schedule",145.8,76,,116.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.41,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",4.41,350,,,,,0,"fee schedule","350% of BCBS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.26,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",86.33,45,,69.06,,,0,"percent of total billed charges","45% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% CMS fee schedule",191.84,100,,,,,0,"fee schedule","100% of CMS fee schedule",124.7,65,,99.76,,,0,"percent of total billed charges","65% of total billed charges",84.6,27,,39.39,39.39,39.39,"1 through 10","percent of total billed charges","27% of total billed charges",182.25,95,,145.80,,,0,"percent of total billed charges","95% of total billed charges",191.84,75,,,,,0,"fee schedule","75% of CMS fee schedule",168.82,88,,135.06,,,0,"percent of total billed charges","88% of total billed charges",172.66,90,,138.13,,,0,"percent of total billed charges","90% of total billed charges",1.26,191.84,
"NIMBEX 10MG/ML 20ML INJ",2720002425,CDM,250,RC,,,Outpatient,,,141.12,70.56,,141.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",107.25,76,,85.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",101.61,72,,81.29,,,0,"percent of total billed charges","72% of total billed charges",105.84,75,,84.67,,,0,"percent of total billed charges","75% of total billed charges",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.61,72,,81.29,,,0,"percent of total billed charges","72% of total billed charges",84.67,60,,67.74,,,0,"percent of total billed charges","60% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",63.5,45,,50.80,,,0,"percent of total billed charges","45% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",141.12,100,,,,,0,"fee schedule","100% CMS fee schedule",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.73,65,,73.38,,,0,"percent of total billed charges","65% of total billed charges",62.23,27,,49.78,,,0,"percent of total billed charges","27% of total billed charges",134.06,95,,107.25,,,0,"percent of total billed charges","95% of total billed charges",141.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",124.19,88,,99.35,,,0,"percent of total billed charges","88% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",62.23,141.12,
"NIMBEX 10MG/ML 20ML INJ",2720002426,CDM,250,RC,,,Outpatient,,,141.12,70.56,,141.12,125,,,,,0,"fee schedule","125% of CMS fee schedule",107.25,76,,85.80,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",101.61,72,,81.29,,,0,"percent of total billed charges","72% of total billed charges",105.84,75,,84.67,,,0,"percent of total billed charges","75% of total billed charges",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",101.61,72,,81.29,,,0,"percent of total billed charges","72% of total billed charges",84.67,60,,67.74,,,0,"percent of total billed charges","60% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",63.5,45,,50.80,,,0,"percent of total billed charges","45% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",141.12,100,,,,,0,"fee schedule","100% CMS fee schedule",141.12,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.73,65,,73.38,,,0,"percent of total billed charges","65% of total billed charges",62.23,27,,49.78,,,0,"percent of total billed charges","27% of total billed charges",134.06,95,,107.25,,,0,"percent of total billed charges","95% of total billed charges",141.12,75,,,,,0,"fee schedule","75% of CMS fee schedule",124.19,88,,99.35,,,0,"percent of total billed charges","88% of total billed charges",127.01,90,,101.61,,,0,"percent of total billed charges","90% of total billed charges",62.23,141.12,
"CLEOCIN 900MG/50ML INJ",2720002429,CDM,250,RC,,,Outpatient,,,92.61,46.305,,92.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",70.38,76,,56.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",66.68,72,,53.34,,,0,"percent of total billed charges","72% of total billed charges",69.46,75,,55.57,,,0,"percent of total billed charges","75% of total billed charges",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.68,72,,53.34,,,0,"percent of total billed charges","72% of total billed charges",55.57,60,,44.46,,,0,"percent of total billed charges","60% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",41.67,45,,33.34,,,0,"percent of total billed charges","45% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.61,100,,,,,0,"fee schedule","100% CMS fee schedule",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.2,65,,48.16,,,0,"percent of total billed charges","65% of total billed charges",40.84,27,,32.67,,,0,"percent of total billed charges","27% of total billed charges",87.98,95,,70.38,,,0,"percent of total billed charges","95% of total billed charges",92.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",81.5,88,,65.20,,,0,"percent of total billed charges","88% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",40.84,92.61,
"CLEOCIN 900MG/50ML INJ",2720002430,CDM,250,RC,,,Outpatient,,,92.61,46.305,,92.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",70.38,76,,56.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",66.68,72,,53.34,,,0,"percent of total billed charges","72% of total billed charges",69.46,75,,55.57,,,0,"percent of total billed charges","75% of total billed charges",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.68,72,,53.34,,,0,"percent of total billed charges","72% of total billed charges",55.57,60,,44.46,,,0,"percent of total billed charges","60% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",41.67,45,,33.34,,,0,"percent of total billed charges","45% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.61,100,,,,,0,"fee schedule","100% CMS fee schedule",92.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.2,65,,48.16,,,0,"percent of total billed charges","65% of total billed charges",40.84,27,,32.67,,,0,"percent of total billed charges","27% of total billed charges",87.98,95,,70.38,,,0,"percent of total billed charges","95% of total billed charges",92.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",81.5,88,,65.20,,,0,"percent of total billed charges","88% of total billed charges",83.35,90,,66.68,,,0,"percent of total billed charges","90% of total billed charges",40.84,92.61,
"PEPCID 20MG/50ML PB INJ",2720002433,CDM,250,RC,J1308,HCPCS,Outpatient,,,38.59,19.295,U8,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"PEPCID 20MG/50ML PB INJ",2720002434,CDM,250,RC,J1308,HCPCS,Outpatient,,,38.59,19.295,U8,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,4.89,4.89,4.89,"1 through 10","percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"CLEOCIN 600MG/50ML INJ",2720002437,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"CLEOCIN 600MG/50ML INJ",2720002438,CDM,250,RC,,,Outpatient,,,76.07,38.035,,76.07,125,,,,,0,"fee schedule","125% of CMS fee schedule",57.81,76,,46.25,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",57.05,75,,45.64,,,0,"percent of total billed charges","75% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.77,72,,43.82,,,0,"percent of total billed charges","72% of total billed charges",45.64,60,,36.51,,,0,"percent of total billed charges","60% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",34.23,45,,27.38,,,0,"percent of total billed charges","45% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% CMS fee schedule",76.07,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.45,65,,39.56,,,0,"percent of total billed charges","65% of total billed charges",33.55,27,,26.84,,,0,"percent of total billed charges","27% of total billed charges",72.27,95,,57.82,,,0,"percent of total billed charges","95% of total billed charges",76.07,75,,,,,0,"fee schedule","75% of CMS fee schedule",66.94,88,,53.55,,,0,"percent of total billed charges","88% of total billed charges",68.46,90,,54.77,,,0,"percent of total billed charges","90% of total billed charges",33.55,76.07,
"CARDIZEM 100MG/10ML INJ",2720002441,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"CARDIZEM 100MG/10ML INJ",2720002442,CDM,250,RC,,,Outpatient,,,47.41,23.705,,47.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.03,76,,28.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",35.56,75,,28.45,,,0,"percent of total billed charges","75% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.14,72,,27.31,,,0,"percent of total billed charges","72% of total billed charges",28.45,60,,22.76,,,0,"percent of total billed charges","60% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",21.33,45,,17.06,,,0,"percent of total billed charges","45% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% CMS fee schedule",47.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.82,65,,24.66,,,0,"percent of total billed charges","65% of total billed charges",20.91,27,,16.73,,,0,"percent of total billed charges","27% of total billed charges",45.04,95,,36.03,,,0,"percent of total billed charges","95% of total billed charges",47.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.72,88,,33.38,,,0,"percent of total billed charges","88% of total billed charges",42.67,90,,34.14,,,0,"percent of total billed charges","90% of total billed charges",20.91,47.41,
"LR1000 W/OXYTOCIN 20 UNIT SOLN",2720002445,CDM,250,RC,,,Outpatient,,,66.15,33.075,,66.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",50.27,76,,40.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",49.61,75,,39.69,,,0,"percent of total billed charges","75% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",39.69,60,,31.75,,,0,"percent of total billed charges","60% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.77,45,,23.82,,,0,"percent of total billed charges","45% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,65,,34.40,,,0,"percent of total billed charges","65% of total billed charges",29.17,27,,23.34,,,0,"percent of total billed charges","27% of total billed charges",62.84,95,,50.27,,,0,"percent of total billed charges","95% of total billed charges",66.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",58.21,88,,46.57,,,0,"percent of total billed charges","88% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.17,66.15,
"LR1000 W/OXYTOCIN 20 UNIT SOLN",2720002446,CDM,250,RC,,,Outpatient,,,66.15,33.075,,66.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",50.27,76,,40.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",49.61,75,,39.69,,,0,"percent of total billed charges","75% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",47.63,72,,38.10,,,0,"percent of total billed charges","72% of total billed charges",39.69,60,,31.75,,,0,"percent of total billed charges","60% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.77,45,,23.82,,,0,"percent of total billed charges","45% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% CMS fee schedule",66.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,65,,34.40,,,0,"percent of total billed charges","65% of total billed charges",29.17,27,,23.34,,,0,"percent of total billed charges","27% of total billed charges",62.84,95,,50.27,,,0,"percent of total billed charges","95% of total billed charges",66.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",58.21,88,,46.57,,,0,"percent of total billed charges","88% of total billed charges",59.54,90,,47.63,,,0,"percent of total billed charges","90% of total billed charges",29.17,66.15,
"RIFAMPIN 600MG VIAL INJ",2720002449,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"RIFAMPIN 600MG VIAL INJ",2720002450,CDM,250,RC,,,Outpatient,,,622.91,311.455,,622.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",473.41,76,,378.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",467.18,75,,373.74,,,0,"percent of total billed charges","75% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",448.5,72,,358.80,,,0,"percent of total billed charges","72% of total billed charges",373.75,60,,299.00,,,0,"percent of total billed charges","60% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",280.31,45,,224.25,,,0,"percent of total billed charges","45% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% CMS fee schedule",622.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",404.89,65,,323.91,,,0,"percent of total billed charges","65% of total billed charges",274.7,27,,219.76,,,0,"percent of total billed charges","27% of total billed charges",591.76,95,,473.41,,,0,"percent of total billed charges","95% of total billed charges",622.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",548.16,88,,438.53,,,0,"percent of total billed charges","88% of total billed charges",560.62,90,,448.50,,,0,"percent of total billed charges","90% of total billed charges",274.7,622.91,
"CARDIZEM 125MG/25ML INJ",2720002453,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"CARDIZEM 125MG/25ML INJ",2720002454,CDM,250,RC,,,Outpatient,,,49.61,24.805,,49.61,125,,,,,0,"fee schedule","125% of CMS fee schedule",37.7,76,,30.16,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",37.21,75,,29.77,,,0,"percent of total billed charges","75% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.72,72,,28.58,,,0,"percent of total billed charges","72% of total billed charges",29.77,60,,23.82,,,0,"percent of total billed charges","60% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",22.32,45,,17.86,,,0,"percent of total billed charges","45% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% CMS fee schedule",49.61,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.25,65,,25.80,,,0,"percent of total billed charges","65% of total billed charges",21.88,27,,17.50,,,0,"percent of total billed charges","27% of total billed charges",47.13,95,,37.70,,,0,"percent of total billed charges","95% of total billed charges",49.61,75,,,,,0,"fee schedule","75% of CMS fee schedule",43.66,88,,34.93,,,0,"percent of total billed charges","88% of total billed charges",44.65,90,,35.72,,,0,"percent of total billed charges","90% of total billed charges",21.88,49.61,
"DEHYDRATED ALCOHOL INJ",2720002457,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"DEHYDRATED ALCOHOL INJ",2720002458,CDM,250,RC,,,Outpatient,,,58.43,29.215,,58.43,125,,,,,0,"fee schedule","125% of CMS fee schedule",44.41,76,,35.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",43.82,75,,35.06,,,0,"percent of total billed charges","75% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.07,72,,33.66,,,0,"percent of total billed charges","72% of total billed charges",35.06,60,,28.05,,,0,"percent of total billed charges","60% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",26.29,45,,21.03,,,0,"percent of total billed charges","45% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% CMS fee schedule",58.43,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.98,65,,30.38,,,0,"percent of total billed charges","65% of total billed charges",25.77,27,,20.62,,,0,"percent of total billed charges","27% of total billed charges",55.51,95,,44.41,,,0,"percent of total billed charges","95% of total billed charges",58.43,75,,,,,0,"fee schedule","75% of CMS fee schedule",51.42,88,,41.14,,,0,"percent of total billed charges","88% of total billed charges",52.59,90,,42.07,,,0,"percent of total billed charges","90% of total billed charges",25.77,58.43,
"CLEOCIN 300MG/50ML INJ",2720002461,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"CLEOCIN 300MG/50ML INJ",2720002462,CDM,250,RC,,,Outpatient,,,60.64,30.32,,60.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",46.09,76,,36.87,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",45.48,75,,36.38,,,0,"percent of total billed charges","75% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.66,72,,34.93,,,0,"percent of total billed charges","72% of total billed charges",36.38,60,,29.10,,,0,"percent of total billed charges","60% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",27.29,45,,21.83,,,0,"percent of total billed charges","45% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% CMS fee schedule",60.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.42,65,,31.54,,,0,"percent of total billed charges","65% of total billed charges",26.74,27,,21.39,,,0,"percent of total billed charges","27% of total billed charges",57.61,95,,46.09,,,0,"percent of total billed charges","95% of total billed charges",60.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",53.36,88,,42.69,,,0,"percent of total billed charges","88% of total billed charges",54.58,90,,43.66,,,0,"percent of total billed charges","90% of total billed charges",26.74,60.64,
"SENSORCAINE0.05%W/EPI INJ",2720002465,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"SENSORCAINE0.05%W/EPI INJ",2720002466,CDM,250,RC,,,Outpatient,,,48.51,24.255,,48.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",36.87,76,,29.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",36.38,75,,29.10,,,0,"percent of total billed charges","75% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.93,72,,27.94,,,0,"percent of total billed charges","72% of total billed charges",29.11,60,,23.29,,,0,"percent of total billed charges","60% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.83,45,,17.46,,,0,"percent of total billed charges","45% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% CMS fee schedule",48.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",31.53,65,,25.22,,,0,"percent of total billed charges","65% of total billed charges",21.39,27,,17.11,,,0,"percent of total billed charges","27% of total billed charges",46.08,95,,36.86,,,0,"percent of total billed charges","95% of total billed charges",48.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",42.69,88,,34.15,,,0,"percent of total billed charges","88% of total billed charges",43.66,90,,34.93,,,0,"percent of total billed charges","90% of total billed charges",21.39,48.51,
"MANNITOL 500ML IV SOLN",2720002469,CDM,250,RC,,,Outpatient,,,337.37,168.685,,337.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",256.4,76,,205.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",242.91,72,,194.33,,,0,"percent of total billed charges","72% of total billed charges",253.03,75,,202.42,,,0,"percent of total billed charges","75% of total billed charges",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.91,72,,194.33,,,0,"percent of total billed charges","72% of total billed charges",202.42,60,,161.94,,,0,"percent of total billed charges","60% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",151.82,45,,121.46,,,0,"percent of total billed charges","45% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.37,100,,,,,0,"fee schedule","100% CMS fee schedule",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",219.29,65,,175.43,,,0,"percent of total billed charges","65% of total billed charges",148.78,27,,119.02,,,0,"percent of total billed charges","27% of total billed charges",320.5,95,,256.40,,,0,"percent of total billed charges","95% of total billed charges",337.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",296.89,88,,237.51,,,0,"percent of total billed charges","88% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",148.78,337.37,
"MANNITOL 500ML IV SOLN",2720002470,CDM,250,RC,,,Outpatient,,,337.37,168.685,,337.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",256.4,76,,205.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",242.91,72,,194.33,,,0,"percent of total billed charges","72% of total billed charges",253.03,75,,202.42,,,0,"percent of total billed charges","75% of total billed charges",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",242.91,72,,194.33,,,0,"percent of total billed charges","72% of total billed charges",202.42,60,,161.94,,,0,"percent of total billed charges","60% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",151.82,45,,121.46,,,0,"percent of total billed charges","45% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",337.37,100,,,,,0,"fee schedule","100% CMS fee schedule",337.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",219.29,65,,175.43,,,0,"percent of total billed charges","65% of total billed charges",148.78,27,,119.02,,,0,"percent of total billed charges","27% of total billed charges",320.5,95,,256.40,,,0,"percent of total billed charges","95% of total billed charges",337.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",296.89,88,,237.51,,,0,"percent of total billed charges","88% of total billed charges",303.63,90,,242.90,,,0,"percent of total billed charges","90% of total billed charges",148.78,337.37,
"SENSORCAINE0.75%10ML INJ",2720002473,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"SENSORCAINE0.75%10ML INJ",2720002474,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"AA8.5/D10WELECTROLYT SOLN",2720002477,CDM,250,RC,,,Outpatient,,,224.91,112.455,,224.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",170.93,76,,136.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",161.94,72,,129.55,,,0,"percent of total billed charges","72% of total billed charges",168.68,75,,134.94,,,0,"percent of total billed charges","75% of total billed charges",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",161.94,72,,129.55,,,0,"percent of total billed charges","72% of total billed charges",134.95,60,,107.96,,,0,"percent of total billed charges","60% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",101.21,45,,80.97,,,0,"percent of total billed charges","45% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.91,100,,,,,0,"fee schedule","100% CMS fee schedule",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.19,65,,116.95,,,0,"percent of total billed charges","65% of total billed charges",99.19,27,,79.35,,,0,"percent of total billed charges","27% of total billed charges",213.66,95,,170.93,,,0,"percent of total billed charges","95% of total billed charges",224.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",197.92,88,,158.34,,,0,"percent of total billed charges","88% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",99.19,224.91,
"AA8.5/D10WELECTROLYT SOLN",2720002478,CDM,250,RC,,,Outpatient,,,224.91,112.455,,224.91,125,,,,,0,"fee schedule","125% of CMS fee schedule",170.93,76,,136.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",161.94,72,,129.55,,,0,"percent of total billed charges","72% of total billed charges",168.68,75,,134.94,,,0,"percent of total billed charges","75% of total billed charges",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",161.94,72,,129.55,,,0,"percent of total billed charges","72% of total billed charges",134.95,60,,107.96,,,0,"percent of total billed charges","60% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",101.21,45,,80.97,,,0,"percent of total billed charges","45% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",224.91,100,,,,,0,"fee schedule","100% CMS fee schedule",224.91,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.19,65,,116.95,,,0,"percent of total billed charges","65% of total billed charges",99.19,27,,79.35,,,0,"percent of total billed charges","27% of total billed charges",213.66,95,,170.93,,,0,"percent of total billed charges","95% of total billed charges",224.91,75,,,,,0,"fee schedule","75% of CMS fee schedule",197.92,88,,158.34,,,0,"percent of total billed charges","88% of total billed charges",202.42,90,,161.94,,,0,"percent of total billed charges","90% of total billed charges",99.19,224.91,
"POTASSIUM PHOSPHATES INJ",2720002481,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"POTASSIUM PHOSPHATES INJ",2720002482,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"DIPRIVAN 1% 100ML INJ",2720002485,CDM,250,RC,J2704,HCPCS,Outpatient,,,54.02,27.01,U8,54.02,125,,,,,0,"fee schedule","125% of CMS fee schedule",41.06,76,,31.69,14.50,47.62,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",24.31,45,,19.45,,,0,"percent of total billed charges","45% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% CMS fee schedule",54.02,100,,,,,0,"fee schedule","100% of CMS fee schedule",35.11,65,,28.09,,,0,"percent of total billed charges","65% of total billed charges",23.82,27,,19.06,,,0,"percent of total billed charges","27% of total billed charges",51.32,95,,41.06,,,0,"percent of total billed charges","95% of total billed charges",54.02,75,,,,,0,"fee schedule","75% of CMS fee schedule",47.54,88,,17.95,15.00,42.37,"1 through 10","percent of total billed charges","88% of total billed charges",48.62,90,,38.90,,,0,"percent of total billed charges","90% of total billed charges",0.07,54.02,
"ZIDOOVUDINE 50MG/5ML INJ",2720002489,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"ZIDOOVUDINE 50MG/5ML INJ",2720002490,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"XYLOCAINE MPF 2% 2ML",2720002493,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"XYLOCAINE MPF 2% 2ML",2720002494,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"MIDAZOLAM 5MG/5ML INJ",2720002497,CDM,250,RC,J2250,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,9.12,8.48,15.76,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.39,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.39,350,,,,,0,"fee schedule","350% of BCBS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.39,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.11,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,0.27,0.17,5.92,"1 through 10","percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,9.77,8.61,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",0.11,6.62,
"MIDAZOLAM 5MG/5ML INJ",2720002498,CDM,250,RC,J2250,HCPCS,Outpatient,,,6.62,3.31,U8,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,9.12,8.48,15.76,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.39,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.39,350,,,,,0,"fee schedule","350% of BCBS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.39,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.11,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,0.27,0.17,5.92,"1 through 10","percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,9.77,8.61,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",0.11,6.62,
"LIDOCAINE 2% WEPI INJ 20ML",2720002501,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LIDOCAINE 2% WEPI INJ 20ML",2720002502,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"XYLOCAINE 2% 10 ML INJ",2720002505,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"XYLOCAINE 2% 10 ML INJ",2720002506,CDM,250,RC,,,Outpatient,,,4.41,2.205,,4.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",3.35,76,,2.68,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",3.31,75,,2.65,,,0,"percent of total billed charges","75% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.18,72,,2.54,,,0,"percent of total billed charges","72% of total billed charges",2.65,60,,2.12,,,0,"percent of total billed charges","60% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.98,45,,1.58,,,0,"percent of total billed charges","45% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% CMS fee schedule",4.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.87,65,,2.30,,,0,"percent of total billed charges","65% of total billed charges",1.94,27,,1.55,,,0,"percent of total billed charges","27% of total billed charges",4.19,95,,3.35,,,0,"percent of total billed charges","95% of total billed charges",4.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",3.88,88,,3.10,,,0,"percent of total billed charges","88% of total billed charges",3.97,90,,3.18,,,0,"percent of total billed charges","90% of total billed charges",1.94,4.41,
"ENION PLUS INJ",2720002509,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"ENION PLUS INJ",2720002510,CDM,250,RC,,,Outpatient,,,14.33,7.165,,14.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.89,76,,8.71,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",10.75,75,,8.60,,,0,"percent of total billed charges","75% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.32,72,,8.26,,,0,"percent of total billed charges","72% of total billed charges",8.6,60,,6.88,,,0,"percent of total billed charges","60% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.45,45,,5.16,,,0,"percent of total billed charges","45% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% CMS fee schedule",14.33,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.31,65,,7.45,,,0,"percent of total billed charges","65% of total billed charges",6.32,27,,5.06,,,0,"percent of total billed charges","27% of total billed charges",13.61,95,,10.89,,,0,"percent of total billed charges","95% of total billed charges",14.33,75,,,,,0,"fee schedule","75% of CMS fee schedule",12.61,88,,10.09,,,0,"percent of total billed charges","88% of total billed charges",12.9,90,,10.32,,,0,"percent of total billed charges","90% of total billed charges",6.32,14.33,
"OFIRMEV 10MG/1ML INJ",2720002513,CDM,250,RC,J0131,HCPCS,Outpatient,,,67.25,33.625,U8,67.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.11,76,,35.72,35.72,649.34,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.91,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.91,350,,,,,0,"fee schedule","350% of BCBS fee schedule",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.91,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.26,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",60.53,90,,33.84,33.84,33.84,"1 through 10","percent of total billed charges","90% of total billed charges",30.26,45,,24.21,,,0,"percent of total billed charges","45% of total billed charges",60.53,90,,48.42,,,0,"percent of total billed charges","90% of total billed charges",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.25,100,,,,,0,"fee schedule","100% CMS fee schedule",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.71,65,,34.97,,,0,"percent of total billed charges","65% of total billed charges",29.66,27,,33.69,19.78,48.93,42,"percent of total billed charges","27% of total billed charges",63.89,95,,51.11,,,0,"percent of total billed charges","95% of total billed charges",67.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",59.18,88,,41.36,18.09,41.37,"1 through 10","percent of total billed charges","88% of total billed charges",60.53,90,,48.42,,,0,"percent of total billed charges","90% of total billed charges",0.26,67.25,
"OFIRMEV 10MG/1ML INJ",2720002514,CDM,250,RC,,,Outpatient,,,67.25,33.625,,67.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",51.11,76,,40.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",48.42,72,,38.74,,,0,"percent of total billed charges","72% of total billed charges",50.44,75,,40.35,,,0,"percent of total billed charges","75% of total billed charges",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.42,72,,38.74,,,0,"percent of total billed charges","72% of total billed charges",40.35,60,,32.28,,,0,"percent of total billed charges","60% of total billed charges",60.53,90,,48.42,,,0,"percent of total billed charges","90% of total billed charges",30.26,45,,24.21,,,0,"percent of total billed charges","45% of total billed charges",60.53,90,,48.42,,,0,"percent of total billed charges","90% of total billed charges",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.25,100,,,,,0,"fee schedule","100% CMS fee schedule",67.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.71,65,,34.97,,,0,"percent of total billed charges","65% of total billed charges",29.66,27,,23.73,,,0,"percent of total billed charges","27% of total billed charges",63.89,95,,51.11,,,0,"percent of total billed charges","95% of total billed charges",67.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",59.18,88,,47.34,,,0,"percent of total billed charges","88% of total billed charges",60.53,90,,48.42,,,0,"percent of total billed charges","90% of total billed charges",29.66,67.25,
"METHOTREXATE 250MG 10ML INJ",2720002521,CDM,250,RC,,,Outpatient,,,87.1,43.55,,87.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",66.2,76,,52.96,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",65.33,75,,52.26,,,0,"percent of total billed charges","75% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",52.26,60,,41.81,,,0,"percent of total billed charges","60% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",39.2,45,,31.36,,,0,"percent of total billed charges","45% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.62,65,,45.30,,,0,"percent of total billed charges","65% of total billed charges",38.41,27,,30.73,,,0,"percent of total billed charges","27% of total billed charges",82.75,95,,66.20,,,0,"percent of total billed charges","95% of total billed charges",87.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",76.65,88,,61.32,,,0,"percent of total billed charges","88% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",38.41,87.1,
"METHOTREXATE 250MG 10ML INJ",2720002522,CDM,250,RC,,,Outpatient,,,87.1,43.55,,87.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",66.2,76,,52.96,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",65.33,75,,52.26,,,0,"percent of total billed charges","75% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",62.71,72,,50.17,,,0,"percent of total billed charges","72% of total billed charges",52.26,60,,41.81,,,0,"percent of total billed charges","60% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",39.2,45,,31.36,,,0,"percent of total billed charges","45% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% CMS fee schedule",87.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.62,65,,45.30,,,0,"percent of total billed charges","65% of total billed charges",38.41,27,,30.73,,,0,"percent of total billed charges","27% of total billed charges",82.75,95,,66.20,,,0,"percent of total billed charges","95% of total billed charges",87.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",76.65,88,,61.32,,,0,"percent of total billed charges","88% of total billed charges",78.39,90,,62.71,,,0,"percent of total billed charges","90% of total billed charges",38.41,87.1,
"LEVOTHYROXINE 100MCG INJ",2720002525,CDM,250,RC,,,Outpatient,,,302.09,151.045,,302.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",229.59,76,,183.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",226.57,75,,181.26,,,0,"percent of total billed charges","75% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",181.25,60,,145.00,,,0,"percent of total billed charges","60% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",135.94,45,,108.75,,,0,"percent of total billed charges","45% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",196.36,65,,157.09,,,0,"percent of total billed charges","65% of total billed charges",133.22,27,,106.58,,,0,"percent of total billed charges","27% of total billed charges",286.99,95,,229.59,,,0,"percent of total billed charges","95% of total billed charges",302.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",265.84,88,,212.67,,,0,"percent of total billed charges","88% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",133.22,302.09,
"LEVOTHYROXINE 100MCG INJ",2720002526,CDM,250,RC,,,Outpatient,,,302.09,151.045,,302.09,125,,,,,0,"fee schedule","125% of CMS fee schedule",229.59,76,,183.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",226.57,75,,181.26,,,0,"percent of total billed charges","75% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.5,72,,174.00,,,0,"percent of total billed charges","72% of total billed charges",181.25,60,,145.00,,,0,"percent of total billed charges","60% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",135.94,45,,108.75,,,0,"percent of total billed charges","45% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% CMS fee schedule",302.09,100,,,,,0,"fee schedule","100% of CMS fee schedule",196.36,65,,157.09,,,0,"percent of total billed charges","65% of total billed charges",133.22,27,,106.58,,,0,"percent of total billed charges","27% of total billed charges",286.99,95,,229.59,,,0,"percent of total billed charges","95% of total billed charges",302.09,75,,,,,0,"fee schedule","75% of CMS fee schedule",265.84,88,,212.67,,,0,"percent of total billed charges","88% of total billed charges",271.88,90,,217.50,,,0,"percent of total billed charges","90% of total billed charges",133.22,302.09,
"FLUMAXENIL 0.5MG/5ML INJ",2720002529,CDM,250,RC,,,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"FLUMAXENIL 0.5MG/5ML INJ",2720002530,CDM,250,RC,,,Outpatient,,,39.69,19.845,,39.69,125,,,,,0,"fee schedule","125% of CMS fee schedule",30.16,76,,24.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",29.77,75,,23.82,,,0,"percent of total billed charges","75% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",28.58,72,,22.86,,,0,"percent of total billed charges","72% of total billed charges",23.81,60,,19.05,,,0,"percent of total billed charges","60% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.86,45,,14.29,,,0,"percent of total billed charges","45% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% CMS fee schedule",39.69,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.8,65,,20.64,,,0,"percent of total billed charges","65% of total billed charges",17.5,27,,14.00,,,0,"percent of total billed charges","27% of total billed charges",37.71,95,,30.17,,,0,"percent of total billed charges","95% of total billed charges",39.69,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.93,88,,27.94,,,0,"percent of total billed charges","88% of total billed charges",35.72,90,,28.58,,,0,"percent of total billed charges","90% of total billed charges",17.5,39.69,
"DUO VISC OPHTH INJ",2720002533,CDM,250,RC,,,Outpatient,,,851.13,425.565,,851.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",646.86,76,,517.49,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",612.81,72,,490.25,,,0,"percent of total billed charges","72% of total billed charges",638.35,75,,510.68,,,0,"percent of total billed charges","75% of total billed charges",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",612.81,72,,490.25,,,0,"percent of total billed charges","72% of total billed charges",510.68,60,,408.54,,,0,"percent of total billed charges","60% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",383.01,45,,306.41,,,0,"percent of total billed charges","45% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",851.13,100,,,,,0,"fee schedule","100% CMS fee schedule",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",553.23,65,,442.58,,,0,"percent of total billed charges","65% of total billed charges",375.35,27,,300.28,,,0,"percent of total billed charges","27% of total billed charges",808.57,95,,646.86,,,0,"percent of total billed charges","95% of total billed charges",851.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",748.99,88,,599.19,,,0,"percent of total billed charges","88% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",375.35,851.13,
"DUO VISC OPHTH INJ",2720002534,CDM,250,RC,,,Outpatient,,,851.13,425.565,,851.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",646.86,76,,517.49,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",612.81,72,,490.25,,,0,"percent of total billed charges","72% of total billed charges",638.35,75,,510.68,,,0,"percent of total billed charges","75% of total billed charges",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",612.81,72,,490.25,,,0,"percent of total billed charges","72% of total billed charges",510.68,60,,408.54,,,0,"percent of total billed charges","60% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",383.01,45,,306.41,,,0,"percent of total billed charges","45% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",851.13,100,,,,,0,"fee schedule","100% CMS fee schedule",851.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",553.23,65,,442.58,,,0,"percent of total billed charges","65% of total billed charges",375.35,27,,300.28,,,0,"percent of total billed charges","27% of total billed charges",808.57,95,,646.86,,,0,"percent of total billed charges","95% of total billed charges",851.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",748.99,88,,599.19,,,0,"percent of total billed charges","88% of total billed charges",766.02,90,,612.82,,,0,"percent of total billed charges","90% of total billed charges",375.35,851.13,
"HEPATITIS B VACCINE",2720002541,CDM,250,RC,,,Outpatient,,,329.65,164.825,,329.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",250.53,76,,200.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",237.35,72,,189.88,,,0,"percent of total billed charges","72% of total billed charges",247.24,75,,197.79,,,0,"percent of total billed charges","75% of total billed charges",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",237.35,72,,189.88,,,0,"percent of total billed charges","72% of total billed charges",197.79,60,,158.23,,,0,"percent of total billed charges","60% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",148.34,45,,118.67,,,0,"percent of total billed charges","45% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",329.65,100,,,,,0,"fee schedule","100% CMS fee schedule",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",214.27,65,,171.42,,,0,"percent of total billed charges","65% of total billed charges",145.38,27,,116.30,,,0,"percent of total billed charges","27% of total billed charges",313.17,95,,250.54,,,0,"percent of total billed charges","95% of total billed charges",329.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",290.09,88,,232.07,,,0,"percent of total billed charges","88% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",145.38,329.65,
"HEPATITIS B VACCINE",2720002542,CDM,250,RC,,,Outpatient,,,329.65,164.825,,329.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",250.53,76,,200.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",237.35,72,,189.88,,,0,"percent of total billed charges","72% of total billed charges",247.24,75,,197.79,,,0,"percent of total billed charges","75% of total billed charges",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",237.35,72,,189.88,,,0,"percent of total billed charges","72% of total billed charges",197.79,60,,158.23,,,0,"percent of total billed charges","60% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",148.34,45,,118.67,,,0,"percent of total billed charges","45% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",329.65,100,,,,,0,"fee schedule","100% CMS fee schedule",329.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",214.27,65,,171.42,,,0,"percent of total billed charges","65% of total billed charges",145.38,27,,116.30,,,0,"percent of total billed charges","27% of total billed charges",313.17,95,,250.54,,,0,"percent of total billed charges","95% of total billed charges",329.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",290.09,88,,232.07,,,0,"percent of total billed charges","88% of total billed charges",296.69,90,,237.35,,,0,"percent of total billed charges","90% of total billed charges",145.38,329.65,
"PENICILLIN G PROCAIN INJ",2720002545,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"PENICILLIN G PROCAIN INJ",2720002546,CDM,250,RC,,,Outpatient,,,78.28,39.14,,78.28,125,,,,,0,"fee schedule","125% of CMS fee schedule",59.49,76,,47.59,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",58.71,75,,46.97,,,0,"percent of total billed charges","75% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",56.36,72,,45.09,,,0,"percent of total billed charges","72% of total billed charges",46.97,60,,37.58,,,0,"percent of total billed charges","60% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",35.23,45,,28.18,,,0,"percent of total billed charges","45% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% CMS fee schedule",78.28,100,,,,,0,"fee schedule","100% of CMS fee schedule",50.88,65,,40.70,,,0,"percent of total billed charges","65% of total billed charges",34.52,27,,27.62,,,0,"percent of total billed charges","27% of total billed charges",74.37,95,,59.50,,,0,"percent of total billed charges","95% of total billed charges",78.28,75,,,,,0,"fee schedule","75% of CMS fee schedule",68.89,88,,55.11,,,0,"percent of total billed charges","88% of total billed charges",70.45,90,,56.36,,,0,"percent of total billed charges","90% of total billed charges",34.52,78.28,
"VITRASE 200 UNITS/ML",2720002549,CDM,250,RC,,,Outpatient,,,275.63,137.815,,275.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",209.48,76,,167.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",198.45,72,,158.76,,,0,"percent of total billed charges","72% of total billed charges",206.72,75,,165.38,,,0,"percent of total billed charges","75% of total billed charges",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,72,,158.76,,,0,"percent of total billed charges","72% of total billed charges",165.38,60,,132.30,,,0,"percent of total billed charges","60% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",124.03,45,,99.22,,,0,"percent of total billed charges","45% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",275.63,100,,,,,0,"fee schedule","100% CMS fee schedule",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.16,65,,143.33,,,0,"percent of total billed charges","65% of total billed charges",121.55,27,,97.24,,,0,"percent of total billed charges","27% of total billed charges",261.85,95,,209.48,,,0,"percent of total billed charges","95% of total billed charges",275.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",242.55,88,,194.04,,,0,"percent of total billed charges","88% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",121.55,275.63,
"VITRASE 200 UNITS/ML",2720002550,CDM,250,RC,,,Outpatient,,,275.63,137.815,,275.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",209.48,76,,167.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",198.45,72,,158.76,,,0,"percent of total billed charges","72% of total billed charges",206.72,75,,165.38,,,0,"percent of total billed charges","75% of total billed charges",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.45,72,,158.76,,,0,"percent of total billed charges","72% of total billed charges",165.38,60,,132.30,,,0,"percent of total billed charges","60% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",124.03,45,,99.22,,,0,"percent of total billed charges","45% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",275.63,100,,,,,0,"fee schedule","100% CMS fee schedule",275.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.16,65,,143.33,,,0,"percent of total billed charges","65% of total billed charges",121.55,27,,97.24,,,0,"percent of total billed charges","27% of total billed charges",261.85,95,,209.48,,,0,"percent of total billed charges","95% of total billed charges",275.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",242.55,88,,194.04,,,0,"percent of total billed charges","88% of total billed charges",248.07,90,,198.46,,,0,"percent of total billed charges","90% of total billed charges",121.55,275.63,
"EPHEDRINE SULF 50MG/ML INJ",2720002553,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"EPHEDRINE SULF 50MG/ML INJ",2720002554,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"LEVOPHED 4MG/4ML INJ",2720002557,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"LEVOPHED 4MG/4ML INJ",2720002558,CDM,250,RC,,,Outpatient,,,20.95,10.475,,20.95,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.92,76,,12.74,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",15.71,75,,12.57,,,0,"percent of total billed charges","75% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.08,72,,12.06,,,0,"percent of total billed charges","72% of total billed charges",12.57,60,,10.06,,,0,"percent of total billed charges","60% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.43,45,,7.54,,,0,"percent of total billed charges","45% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% CMS fee schedule",20.95,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.62,65,,10.90,,,0,"percent of total billed charges","65% of total billed charges",9.24,27,,7.39,,,0,"percent of total billed charges","27% of total billed charges",19.9,95,,15.92,,,0,"percent of total billed charges","95% of total billed charges",20.95,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.44,88,,14.75,,,0,"percent of total billed charges","88% of total billed charges",18.86,90,,15.09,,,0,"percent of total billed charges","90% of total billed charges",9.24,20.95,
"SUFENTA 50MCG/1ML INJ",2720002561,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"SUFENTA 50MCG/1ML INJ",2720002562,CDM,250,RC,,,Outpatient,,,18.74,9.37,,18.74,125,,,,,0,"fee schedule","125% of CMS fee schedule",14.24,76,,11.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",14.06,75,,11.25,,,0,"percent of total billed charges","75% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.49,72,,10.79,,,0,"percent of total billed charges","72% of total billed charges",11.24,60,,8.99,,,0,"percent of total billed charges","60% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.43,45,,6.74,,,0,"percent of total billed charges","45% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% CMS fee schedule",18.74,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.18,65,,9.74,,,0,"percent of total billed charges","65% of total billed charges",8.26,27,,6.61,,,0,"percent of total billed charges","27% of total billed charges",17.8,95,,14.24,,,0,"percent of total billed charges","95% of total billed charges",18.74,75,,,,,0,"fee schedule","75% of CMS fee schedule",16.49,88,,13.19,,,0,"percent of total billed charges","88% of total billed charges",16.87,90,,13.50,,,0,"percent of total billed charges","90% of total billed charges",8.26,18.74,
"THORAZINE 25MG/1ML INJ",2720002565,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"THORAZINE 25MG/1ML INJ",2720002566,CDM,250,RC,,,Outpatient,,,88.2,44.1,,88.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",67.03,76,,53.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",66.15,75,,52.92,,,0,"percent of total billed charges","75% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",63.5,72,,50.80,,,0,"percent of total billed charges","72% of total billed charges",52.92,60,,42.34,,,0,"percent of total billed charges","60% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",39.69,45,,31.75,,,0,"percent of total billed charges","45% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% CMS fee schedule",88.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.33,65,,45.86,,,0,"percent of total billed charges","65% of total billed charges",38.9,27,,31.12,,,0,"percent of total billed charges","27% of total billed charges",83.79,95,,67.03,,,0,"percent of total billed charges","95% of total billed charges",88.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",77.62,88,,62.10,,,0,"percent of total billed charges","88% of total billed charges",79.38,90,,63.50,,,0,"percent of total billed charges","90% of total billed charges",38.9,88.2,
"ATRACURIUM 10ML INJ",2720002569,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"ATRACURIUM 10ML INJ",2720002570,CDM,250,RC,,,Outpatient,,,71.66,35.83,,71.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.46,76,,43.57,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",53.75,75,,43.00,,,0,"percent of total billed charges","75% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",51.6,72,,41.28,,,0,"percent of total billed charges","72% of total billed charges",43,60,,34.40,,,0,"percent of total billed charges","60% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",32.25,45,,25.80,,,0,"percent of total billed charges","45% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% CMS fee schedule",71.66,100,,,,,0,"fee schedule","100% of CMS fee schedule",46.58,65,,37.26,,,0,"percent of total billed charges","65% of total billed charges",31.6,27,,25.28,,,0,"percent of total billed charges","27% of total billed charges",68.08,95,,54.46,,,0,"percent of total billed charges","95% of total billed charges",71.66,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.06,88,,50.45,,,0,"percent of total billed charges","88% of total billed charges",64.49,90,,51.59,,,0,"percent of total billed charges","90% of total billed charges",31.6,71.66,
"DEPACON 100MG INJ",2720002573,CDM,250,RC,J3490,HCPCS,Outpatient,,,43,21.5,U8,43,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.68,76,,30.78,30.78,30.78,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",32.25,75,,11.77,8.95,15.63,"1 through 10","percent of total billed charges","75% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",25.8,60,,20.64,,,0,"percent of total billed charges","60% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",19.35,45,,15.48,,,0,"percent of total billed charges","45% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,100,,,,,0,"fee schedule","100% CMS fee schedule",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.95,65,,22.36,,,0,"percent of total billed charges","65% of total billed charges",18.96,27,,54.61,17.53,91.68,"1 through 10","percent of total billed charges","27% of total billed charges",40.85,95,,32.68,,,0,"percent of total billed charges","95% of total billed charges",43,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.84,88,,26.73,19.60,33.86,"1 through 10","percent of total billed charges","88% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",18.96,43,
"DEPACON 100MG INJ",2720002574,CDM,250,RC,,,Outpatient,,,43,21.5,,43,125,,,,,0,"fee schedule","125% of CMS fee schedule",32.68,76,,26.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",32.25,75,,25.80,,,0,"percent of total billed charges","75% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.96,72,,24.77,,,0,"percent of total billed charges","72% of total billed charges",25.8,60,,20.64,,,0,"percent of total billed charges","60% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",19.35,45,,15.48,,,0,"percent of total billed charges","45% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",43,100,,,,,0,"fee schedule","100% CMS fee schedule",43,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.95,65,,22.36,,,0,"percent of total billed charges","65% of total billed charges",18.96,27,,15.17,,,0,"percent of total billed charges","27% of total billed charges",40.85,95,,32.68,,,0,"percent of total billed charges","95% of total billed charges",43,75,,,,,0,"fee schedule","75% of CMS fee schedule",37.84,88,,30.27,,,0,"percent of total billed charges","88% of total billed charges",38.7,90,,30.96,,,0,"percent of total billed charges","90% of total billed charges",18.96,43,
"BUMEX 0.25MG/ML 10ML",2720002577,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"BUMEX 0.25MG/ML 10ML",2720002578,CDM,250,RC,,,Outpatient,,,9.92,4.96,,9.92,125,,,,,0,"fee schedule","125% of CMS fee schedule",7.54,76,,6.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",7.44,75,,5.95,,,0,"percent of total billed charges","75% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.14,72,,5.71,,,0,"percent of total billed charges","72% of total billed charges",5.95,60,,4.76,,,0,"percent of total billed charges","60% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.46,45,,3.57,,,0,"percent of total billed charges","45% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% CMS fee schedule",9.92,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.45,65,,5.16,,,0,"percent of total billed charges","65% of total billed charges",4.37,27,,3.50,,,0,"percent of total billed charges","27% of total billed charges",9.42,95,,7.54,,,0,"percent of total billed charges","95% of total billed charges",9.92,75,,,,,0,"fee schedule","75% of CMS fee schedule",8.73,88,,6.98,,,0,"percent of total billed charges","88% of total billed charges",8.93,90,,7.14,,,0,"percent of total billed charges","90% of total billed charges",4.37,9.92,
"PROPOFOL 10MG/ML 50ML INJ",2720002581,CDM,250,RC,J2704,HCPCS,Outpatient,,,177.5,88.75,U8,177.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",134.9,76,,31.69,14.50,47.62,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",79.88,45,,63.90,,,0,"percent of total billed charges","45% of total billed charges",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",177.5,100,,,,,0,"fee schedule","100% CMS fee schedule",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.38,65,,92.30,,,0,"percent of total billed charges","65% of total billed charges",78.28,27,,62.62,,,0,"percent of total billed charges","27% of total billed charges",168.63,95,,134.90,,,0,"percent of total billed charges","95% of total billed charges",177.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",156.2,88,,17.95,15.00,42.37,"1 through 10","percent of total billed charges","88% of total billed charges",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",0.07,177.5,
"PROPOFOL 10MG/ML 50ML INJ",2720002582,CDM,250,RC,J2704,HCPCS,Outpatient,,,177.5,88.75,U8,177.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",134.9,76,,31.69,14.50,47.62,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",79.88,45,,63.90,,,0,"percent of total billed charges","45% of total billed charges",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",177.5,100,,,,,0,"fee schedule","100% CMS fee schedule",177.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.38,65,,92.30,,,0,"percent of total billed charges","65% of total billed charges",78.28,27,,62.62,,,0,"percent of total billed charges","27% of total billed charges",168.63,95,,134.90,,,0,"percent of total billed charges","95% of total billed charges",177.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",156.2,88,,17.95,15.00,42.37,"1 through 10","percent of total billed charges","88% of total billed charges",159.75,90,,127.80,,,0,"percent of total billed charges","90% of total billed charges",0.07,177.5,
"CLINIMIX E/D50 AA 8",2720002585,CDM,250,RC,,,Outpatient,,,248.06,124.03,,248.06,125,,,,,0,"fee schedule","125% of CMS fee schedule",188.53,76,,150.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",178.6,72,,142.88,,,0,"percent of total billed charges","72% of total billed charges",186.05,75,,148.84,,,0,"percent of total billed charges","75% of total billed charges",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.6,72,,142.88,,,0,"percent of total billed charges","72% of total billed charges",148.84,60,,119.07,,,0,"percent of total billed charges","60% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",111.63,45,,89.30,,,0,"percent of total billed charges","45% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",248.06,100,,,,,0,"fee schedule","100% CMS fee schedule",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",161.24,65,,128.99,,,0,"percent of total billed charges","65% of total billed charges",109.39,27,,87.51,,,0,"percent of total billed charges","27% of total billed charges",235.66,95,,188.53,,,0,"percent of total billed charges","95% of total billed charges",248.06,75,,,,,0,"fee schedule","75% of CMS fee schedule",218.29,88,,174.63,,,0,"percent of total billed charges","88% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",109.39,248.06,
"CLINIMIX E/D50 AA 8",2720002586,CDM,250,RC,,,Outpatient,,,248.06,124.03,,248.06,125,,,,,0,"fee schedule","125% of CMS fee schedule",188.53,76,,150.82,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",178.6,72,,142.88,,,0,"percent of total billed charges","72% of total billed charges",186.05,75,,148.84,,,0,"percent of total billed charges","75% of total billed charges",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",178.6,72,,142.88,,,0,"percent of total billed charges","72% of total billed charges",148.84,60,,119.07,,,0,"percent of total billed charges","60% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",111.63,45,,89.30,,,0,"percent of total billed charges","45% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",248.06,100,,,,,0,"fee schedule","100% CMS fee schedule",248.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",161.24,65,,128.99,,,0,"percent of total billed charges","65% of total billed charges",109.39,27,,87.51,,,0,"percent of total billed charges","27% of total billed charges",235.66,95,,188.53,,,0,"percent of total billed charges","95% of total billed charges",248.06,75,,,,,0,"fee schedule","75% of CMS fee schedule",218.29,88,,174.63,,,0,"percent of total billed charges","88% of total billed charges",223.25,90,,178.60,,,0,"percent of total billed charges","90% of total billed charges",109.39,248.06,
"HECTEROL 2MCG/ML 2ML",2720002589,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"HECTEROL 2MCG/ML 2ML",2720002590,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"INTRALIPID 10% 500ML",2720002593,CDM,250,RC,,,Outpatient,,,222.71,111.355,,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,135.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,133.62,,,0,"percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,78.58,,,0,"percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,156.78,,,0,"percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"INTRALIPID 10% 500ML",2720002594,CDM,250,RC,,,Outpatient,,,222.71,111.355,,222.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",169.26,76,,135.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",167.03,75,,133.62,,,0,"percent of total billed charges","75% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",160.35,72,,128.28,,,0,"percent of total billed charges","72% of total billed charges",133.63,60,,106.90,,,0,"percent of total billed charges","60% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",100.22,45,,80.18,,,0,"percent of total billed charges","45% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% CMS fee schedule",222.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.76,65,,115.81,,,0,"percent of total billed charges","65% of total billed charges",98.22,27,,78.58,,,0,"percent of total billed charges","27% of total billed charges",211.57,95,,169.26,,,0,"percent of total billed charges","95% of total billed charges",222.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",195.98,88,,156.78,,,0,"percent of total billed charges","88% of total billed charges",200.44,90,,160.35,,,0,"percent of total billed charges","90% of total billed charges",98.22,222.71,
"MORPHINE SULFATE 5MG",2720002597,CDM,250,RC,J2270,HCPCS,Outpatient,,,29.77,14.885,U8,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,9.82,9.82,9.82,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",26.79,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,5.98,5.11,12.28,23,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,10.03,6.94,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",0.07,29.77,
"MORPHINE SULFATE 5MG",2720002598,CDM,250,RC,J2270,HCPCS,Outpatient,,,29.77,14.885,U8,29.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",22.63,76,,9.82,9.82,9.82,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",26.79,90,,8.64,8.64,8.64,"1 through 10","percent of total billed charges","90% of total billed charges",13.4,45,,10.72,,,0,"percent of total billed charges","45% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% CMS fee schedule",29.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",19.35,65,,15.48,,,0,"percent of total billed charges","65% of total billed charges",13.13,27,,5.98,5.11,12.28,23,"percent of total billed charges","27% of total billed charges",28.28,95,,22.62,,,0,"percent of total billed charges","95% of total billed charges",29.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",26.2,88,,10.03,6.94,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",26.79,90,,21.43,,,0,"percent of total billed charges","90% of total billed charges",0.07,29.77,
"ZOSYN 4.5 GRAM VIAL",2720002601,CDM,250,RC,J2543,HCPCS,Outpatient,,,132.3,66.15,U8,132.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",100.55,76,,51.57,51.57,51.57,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.96,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",8.96,350,,,,,0,"fee schedule","350% of BCBS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.56,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",59.54,45,,47.63,,,0,"percent of total billed charges","45% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",132.3,100,,57.15,57.15,57.15,"1 through 10","fee schedule","100% of CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,65,,68.80,,,0,"percent of total billed charges","65% of total billed charges",58.34,27,,4.65,3.52,31.83,22,"percent of total billed charges","27% of total billed charges",125.69,95,,100.55,,,0,"percent of total billed charges","95% of total billed charges",132.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",116.42,88,,47.78,47.78,47.78,"1 through 10","percent of total billed charges","88% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",2.56,132.3,
"ZOSYN 4.5 GRAM VIAL",2720002602,CDM,250,RC,J2543,HCPCS,Outpatient,,,132.3,66.15,U8,132.3,125,,,,,0,"fee schedule","125% of CMS fee schedule",100.55,76,,51.57,51.57,51.57,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.96,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",8.96,350,,,,,0,"fee schedule","350% of BCBS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.96,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.56,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",59.54,45,,47.63,,,0,"percent of total billed charges","45% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",132.3,100,,57.15,57.15,57.15,"1 through 10","fee schedule","100% of CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% CMS fee schedule",132.3,100,,,,,0,"fee schedule","100% of CMS fee schedule",86,65,,68.80,,,0,"percent of total billed charges","65% of total billed charges",58.34,27,,4.65,3.52,31.83,22,"percent of total billed charges","27% of total billed charges",125.69,95,,100.55,,,0,"percent of total billed charges","95% of total billed charges",132.3,75,,,,,0,"fee schedule","75% of CMS fee schedule",116.42,88,,47.78,47.78,47.78,"1 through 10","percent of total billed charges","88% of total billed charges",119.07,90,,95.26,,,0,"percent of total billed charges","90% of total billed charges",2.56,132.3,
"AMIODARONE 360MG/D5",2720002605,CDM,250,RC,J0282,HCPCS,Outpatient,,,251.37,125.685,U8,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.7,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,10.56,10.56,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",0.2,251.37,
"AMIODARONE 360MG/D5",2720002606,CDM,250,RC,J0282,HCPCS,Outpatient,,,251.37,125.685,U8,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.7,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.7,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,10.56,10.56,10.56,"1 through 10","percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",0.2,251.37,
"RELISTOR 12MG/06 ML",2720002609,CDM,250,RC,,,Outpatient,,,252.47,126.235,,252.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.88,76,,153.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",181.78,72,,145.42,,,0,"percent of total billed charges","72% of total billed charges",189.35,75,,151.48,,,0,"percent of total billed charges","75% of total billed charges",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.78,72,,145.42,,,0,"percent of total billed charges","72% of total billed charges",151.48,60,,121.18,,,0,"percent of total billed charges","60% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",113.61,45,,90.89,,,0,"percent of total billed charges","45% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",252.47,100,,,,,0,"fee schedule","100% CMS fee schedule",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.11,65,,131.29,,,0,"percent of total billed charges","65% of total billed charges",111.34,27,,89.07,,,0,"percent of total billed charges","27% of total billed charges",239.85,95,,191.88,,,0,"percent of total billed charges","95% of total billed charges",252.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",222.17,88,,177.74,,,0,"percent of total billed charges","88% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",111.34,252.47,
"RELISTOR 12MG/06 ML",2720002610,CDM,250,RC,,,Outpatient,,,252.47,126.235,,252.47,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.88,76,,153.50,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",181.78,72,,145.42,,,0,"percent of total billed charges","72% of total billed charges",189.35,75,,151.48,,,0,"percent of total billed charges","75% of total billed charges",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",181.78,72,,145.42,,,0,"percent of total billed charges","72% of total billed charges",151.48,60,,121.18,,,0,"percent of total billed charges","60% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",113.61,45,,90.89,,,0,"percent of total billed charges","45% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",252.47,100,,,,,0,"fee schedule","100% CMS fee schedule",252.47,100,,,,,0,"fee schedule","100% of CMS fee schedule",164.11,65,,131.29,,,0,"percent of total billed charges","65% of total billed charges",111.34,27,,89.07,,,0,"percent of total billed charges","27% of total billed charges",239.85,95,,191.88,,,0,"percent of total billed charges","95% of total billed charges",252.47,75,,,,,0,"fee schedule","75% of CMS fee schedule",222.17,88,,177.74,,,0,"percent of total billed charges","88% of total billed charges",227.22,90,,181.78,,,0,"percent of total billed charges","90% of total billed charges",111.34,252.47,
"TEFLARO 600MG INJ",2720002617,CDM,636,RC,J0712,HCPCS,Outpatient,,,15.37,7.685,U8,4.93,100,,,,,0,"fee schedule","100% of CMS OPPS rate",11.68,76,,9.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.38,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",9.38,350,,,,,0,"fee schedule","350% of BCBS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.38,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.68,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",13.83,90,,11.06,,,0,"percent of total billed charges","90% of total billed charges",6.92,45,,5.54,,,0,"percent of total billed charges","45% of total billed charges",13.83,90,,11.06,,,0,"percent of total billed charges","90% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",17.89,65,,14.31,,,0,"percent of total billed charges","65% of total billed charges",6.78,27,,5.42,,,0,"percent of total billed charges","27% of total billed charges",14.6,95,,11.68,,,0,"percent of total billed charges","95% of total billed charges",2.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",13.53,88,,10.82,,,0,"percent of total billed charges","88% of total billed charges",13.83,90,,11.06,,,0,"percent of total billed charges","90% of total billed charges",2.68,17.89,
"TEFLARO 600MG INJ",2720002618,CDM,636,RC,J0712,HCPCS,Outpatient,,,238.14,119.07,U8,4.93,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.99,76,,144.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.38,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",9.38,350,,,,,0,"fee schedule","350% of BCBS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.38,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.68,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",107.16,45,,85.73,,,0,"percent of total billed charges","45% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.69,65,,130.15,,,0,"percent of total billed charges","65% of total billed charges",105.02,27,,84.02,,,0,"percent of total billed charges","27% of total billed charges",226.23,95,,180.98,,,0,"percent of total billed charges","95% of total billed charges",2.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",209.56,88,,167.65,,,0,"percent of total billed charges","88% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",2.68,226.23,
"TEFLARO 400 MG INJ",2720002621,CDM,636,RC,J0712,HCPCS,Outpatient,,,238.14,119.07,U8,4.93,100,,,,,0,"fee schedule","100% of CMS OPPS rate",180.99,76,,144.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.38,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",9.38,350,,,,,0,"fee schedule","350% of BCBS fee schedule",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.38,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.68,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",107.16,45,,85.73,,,0,"percent of total billed charges","45% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",3.95,100,,,,,0,"fee schedule","100% of CMS OPPS rate",162.69,65,,130.15,,,0,"percent of total billed charges","65% of total billed charges",105.02,27,,84.02,,,0,"percent of total billed charges","27% of total billed charges",226.23,95,,180.98,,,0,"percent of total billed charges","95% of total billed charges",2.96,100,,,,,0,"fee schedule","100% of CMS OPPS rate",209.56,88,,167.65,,,0,"percent of total billed charges","88% of total billed charges",214.33,90,,171.46,,,0,"percent of total billed charges","90% of total billed charges",2.68,226.23,
"DAKIN'S SOLUTION",2720002629,CDM,250,RC,,,Outpatient,,,45,22.5,,45,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.2,76,,27.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.4,72,,25.92,,,0,"percent of total billed charges","72% of total billed charges",33.75,75,,27.00,,,0,"percent of total billed charges","75% of total billed charges",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.4,72,,25.92,,,0,"percent of total billed charges","72% of total billed charges",27,60,,21.60,,,0,"percent of total billed charges","60% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",20.25,45,,16.20,,,0,"percent of total billed charges","45% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",45,100,,,,,0,"fee schedule","100% CMS fee schedule",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.25,65,,23.40,,,0,"percent of total billed charges","65% of total billed charges",19.85,27,,15.88,,,0,"percent of total billed charges","27% of total billed charges",42.75,95,,34.20,,,0,"percent of total billed charges","95% of total billed charges",45,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.6,88,,31.68,,,0,"percent of total billed charges","88% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,
"DAKIN'S SOLUTION",2720002630,CDM,250,RC,,,Outpatient,,,45,22.5,,45,125,,,,,0,"fee schedule","125% of CMS fee schedule",34.2,76,,27.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",32.4,72,,25.92,,,0,"percent of total billed charges","72% of total billed charges",33.75,75,,27.00,,,0,"percent of total billed charges","75% of total billed charges",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",32.4,72,,25.92,,,0,"percent of total billed charges","72% of total billed charges",27,60,,21.60,,,0,"percent of total billed charges","60% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",20.25,45,,16.20,,,0,"percent of total billed charges","45% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",45,100,,,,,0,"fee schedule","100% CMS fee schedule",45,100,,,,,0,"fee schedule","100% of CMS fee schedule",29.25,65,,23.40,,,0,"percent of total billed charges","65% of total billed charges",19.85,27,,15.88,,,0,"percent of total billed charges","27% of total billed charges",42.75,95,,34.20,,,0,"percent of total billed charges","95% of total billed charges",45,75,,,,,0,"fee schedule","75% of CMS fee schedule",39.6,88,,31.68,,,0,"percent of total billed charges","88% of total billed charges",40.5,90,,32.40,,,0,"percent of total billed charges","90% of total billed charges",19.85,45,
"STERIL H2O FOR INJ 20ML",2720002633,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"STERIL H2O FOR INJ 20ML",2720002634,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"STERIL H20 FOR INJ 50ML",2720002637,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"STERIL H20 FOR INJ 50ML",2720002638,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"STERILE H2O  FOR INH 3000ML",2720002641,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"STERILE H2O  FOR INH 3000ML",2720002642,CDM,250,RC,,,Outpatient,,,36.38,18.19,,36.38,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.65,76,,22.12,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",27.29,75,,21.83,,,0,"percent of total billed charges","75% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",26.19,72,,20.95,,,0,"percent of total billed charges","72% of total billed charges",21.83,60,,17.46,,,0,"percent of total billed charges","60% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.37,45,,13.10,,,0,"percent of total billed charges","45% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% CMS fee schedule",36.38,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.65,65,,18.92,,,0,"percent of total billed charges","65% of total billed charges",16.04,27,,12.83,,,0,"percent of total billed charges","27% of total billed charges",34.56,95,,27.65,,,0,"percent of total billed charges","95% of total billed charges",36.38,75,,,,,0,"fee schedule","75% of CMS fee schedule",32.01,88,,25.61,,,0,"percent of total billed charges","88% of total billed charges",32.74,90,,26.19,,,0,"percent of total billed charges","90% of total billed charges",16.04,36.38,
"SOD CHLORIDE FOR INJ 20ML",2720002645,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SOD CHLORIDE FOR INJ 20ML",2720002646,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SOD CHLORIDE FOR INJ 20ML",2720002649,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"SOD CHLORIDE FOR INJ 20ML",2720002650,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"PT BACITRACIN + ZINC 1 OZ",2720002677,CDM,250,RC,,,Outpatient,,,20.83,10.415,,20.83,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.83,76,,12.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15,72,,12.00,,,0,"percent of total billed charges","72% of total billed charges",15.62,75,,12.50,,,0,"percent of total billed charges","75% of total billed charges",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",15,72,,12.00,,,0,"percent of total billed charges","72% of total billed charges",12.5,60,,10.00,,,0,"percent of total billed charges","60% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",9.37,45,,7.50,,,0,"percent of total billed charges","45% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.83,100,,,,,0,"fee schedule","100% CMS fee schedule",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,65,,10.83,,,0,"percent of total billed charges","65% of total billed charges",9.19,27,,7.35,,,0,"percent of total billed charges","27% of total billed charges",19.79,95,,15.83,,,0,"percent of total billed charges","95% of total billed charges",20.83,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.33,88,,14.66,,,0,"percent of total billed charges","88% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",9.19,20.83,
"PT BACITRACIN + ZINC 1 OZ",2720002678,CDM,250,RC,,,Outpatient,,,20.83,10.415,,20.83,125,,,,,0,"fee schedule","125% of CMS fee schedule",15.83,76,,12.66,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15,72,,12.00,,,0,"percent of total billed charges","72% of total billed charges",15.62,75,,12.50,,,0,"percent of total billed charges","75% of total billed charges",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",15,72,,12.00,,,0,"percent of total billed charges","72% of total billed charges",12.5,60,,10.00,,,0,"percent of total billed charges","60% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",9.37,45,,7.50,,,0,"percent of total billed charges","45% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",20.83,100,,,,,0,"fee schedule","100% CMS fee schedule",20.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.54,65,,10.83,,,0,"percent of total billed charges","65% of total billed charges",9.19,27,,7.35,,,0,"percent of total billed charges","27% of total billed charges",19.79,95,,15.83,,,0,"percent of total billed charges","95% of total billed charges",20.83,75,,,,,0,"fee schedule","75% of CMS fee schedule",18.33,88,,14.66,,,0,"percent of total billed charges","88% of total billed charges",18.75,90,,15.00,,,0,"percent of total billed charges","90% of total billed charges",9.19,20.83,
"PT NEOSPORIN 0.5 OZ",2720002681,CDM,250,RC,,,Outpatient,,,38.71,19.355,,38.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.42,76,,23.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.87,72,,22.30,,,0,"percent of total billed charges","72% of total billed charges",29.03,75,,23.22,,,0,"percent of total billed charges","75% of total billed charges",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.87,72,,22.30,,,0,"percent of total billed charges","72% of total billed charges",23.23,60,,18.58,,,0,"percent of total billed charges","60% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",17.42,45,,13.94,,,0,"percent of total billed charges","45% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.71,100,,,,,0,"fee schedule","100% CMS fee schedule",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,65,,20.13,,,0,"percent of total billed charges","65% of total billed charges",17.07,27,,13.66,,,0,"percent of total billed charges","27% of total billed charges",36.77,95,,29.42,,,0,"percent of total billed charges","95% of total billed charges",38.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.06,88,,27.25,,,0,"percent of total billed charges","88% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",17.07,38.71,
"PT NEOSPORIN 0.5 OZ",2720002682,CDM,250,RC,,,Outpatient,,,38.71,19.355,,38.71,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.42,76,,23.54,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.87,72,,22.30,,,0,"percent of total billed charges","72% of total billed charges",29.03,75,,23.22,,,0,"percent of total billed charges","75% of total billed charges",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.87,72,,22.30,,,0,"percent of total billed charges","72% of total billed charges",23.23,60,,18.58,,,0,"percent of total billed charges","60% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",17.42,45,,13.94,,,0,"percent of total billed charges","45% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.71,100,,,,,0,"fee schedule","100% CMS fee schedule",38.71,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.16,65,,20.13,,,0,"percent of total billed charges","65% of total billed charges",17.07,27,,13.66,,,0,"percent of total billed charges","27% of total billed charges",36.77,95,,29.42,,,0,"percent of total billed charges","95% of total billed charges",38.71,75,,,,,0,"fee schedule","75% of CMS fee schedule",34.06,88,,27.25,,,0,"percent of total billed charges","88% of total billed charges",34.84,90,,27.87,,,0,"percent of total billed charges","90% of total billed charges",17.07,38.71,
"AMICAR 500MG TAB",2720002685,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"AMICAR 500MG TAB",2720002686,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PROVENTIL 4MG TAB",2720002689,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROVENTIL 4MG TAB",2720002690,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"PROVENTIL REPETABS 4MG",2720002693,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PROVENTIL REPETABS 4MG",2720002694,CDM,250,RC,,,Outpatient,,,7.72,3.86,,7.72,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.87,76,,4.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",5.79,75,,4.63,,,0,"percent of total billed charges","75% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.56,72,,4.45,,,0,"percent of total billed charges","72% of total billed charges",4.63,60,,3.70,,,0,"percent of total billed charges","60% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.47,45,,2.78,,,0,"percent of total billed charges","45% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% CMS fee schedule",7.72,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.02,65,,4.02,,,0,"percent of total billed charges","65% of total billed charges",3.4,27,,2.72,,,0,"percent of total billed charges","27% of total billed charges",7.33,95,,5.86,,,0,"percent of total billed charges","95% of total billed charges",7.72,75,,,,,0,"fee schedule","75% of CMS fee schedule",6.79,88,,5.43,,,0,"percent of total billed charges","88% of total billed charges",6.95,90,,5.56,,,0,"percent of total billed charges","90% of total billed charges",3.4,7.72,
"PROVENTIL 2MG/5ML SYRUP",2720002697,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"PROVENTIL 2MG/5ML SYRUP",2720002698,CDM,250,RC,,,Outpatient,,,1.1,0.55,,1.1,125,,,,,0,"fee schedule","125% of CMS fee schedule",0.84,76,,0.67,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.83,75,,0.66,,,0,"percent of total billed charges","75% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.79,72,,0.63,,,0,"percent of total billed charges","72% of total billed charges",0.66,60,,0.53,,,0,"percent of total billed charges","60% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.5,45,,0.40,,,0,"percent of total billed charges","45% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% CMS fee schedule",1.1,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.72,65,,0.58,,,0,"percent of total billed charges","65% of total billed charges",0.49,27,,0.39,,,0,"percent of total billed charges","27% of total billed charges",1.05,95,,0.84,,,0,"percent of total billed charges","95% of total billed charges",1.1,75,,,,,0,"fee schedule","75% of CMS fee schedule",0.97,88,,0.78,,,0,"percent of total billed charges","88% of total billed charges",0.99,90,,0.79,,,0,"percent of total billed charges","90% of total billed charges",0.49,1.1,
"ALBUTEROL 2MG TAB",2720002701,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ALBUTEROL 2MG TAB",2720002702,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ZOVIRAX 200MG/5ML SUSP",2720002705,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ZOVIRAX 200MG/5ML SUSP",2720002706,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"ZOVIRAX OINT 15GM",2720002709,CDM,250,RC,,,Outpatient,,,813.65,406.825,,813.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",618.37,76,,494.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",585.83,72,,468.66,,,0,"percent of total billed charges","72% of total billed charges",610.24,75,,488.19,,,0,"percent of total billed charges","75% of total billed charges",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",585.83,72,,468.66,,,0,"percent of total billed charges","72% of total billed charges",488.19,60,,390.55,,,0,"percent of total billed charges","60% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",366.14,45,,292.91,,,0,"percent of total billed charges","45% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",813.65,100,,,,,0,"fee schedule","100% CMS fee schedule",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",528.87,65,,423.10,,,0,"percent of total billed charges","65% of total billed charges",358.82,27,,287.06,,,0,"percent of total billed charges","27% of total billed charges",772.97,95,,618.38,,,0,"percent of total billed charges","95% of total billed charges",813.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",716.01,88,,572.81,,,0,"percent of total billed charges","88% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",358.82,813.65,
"ZOVIRAX OINT 15GM",2720002710,CDM,250,RC,,,Outpatient,,,813.65,406.825,,813.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",618.37,76,,494.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",585.83,72,,468.66,,,0,"percent of total billed charges","72% of total billed charges",610.24,75,,488.19,,,0,"percent of total billed charges","75% of total billed charges",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",585.83,72,,468.66,,,0,"percent of total billed charges","72% of total billed charges",488.19,60,,390.55,,,0,"percent of total billed charges","60% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",366.14,45,,292.91,,,0,"percent of total billed charges","45% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",813.65,100,,,,,0,"fee schedule","100% CMS fee schedule",813.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",528.87,65,,423.10,,,0,"percent of total billed charges","65% of total billed charges",358.82,27,,287.06,,,0,"percent of total billed charges","27% of total billed charges",772.97,95,,618.38,,,0,"percent of total billed charges","95% of total billed charges",813.65,75,,,,,0,"fee schedule","75% of CMS fee schedule",716.01,88,,572.81,,,0,"percent of total billed charges","88% of total billed charges",732.29,90,,585.83,,,0,"percent of total billed charges","90% of total billed charges",358.82,813.65,
"ZOVIRAX 5% CREAM",2720002713,CDM,250,RC,,,Outpatient,,,509.36,254.68,,509.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",387.11,76,,309.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",366.74,72,,293.39,,,0,"percent of total billed charges","72% of total billed charges",382.02,75,,305.62,,,0,"percent of total billed charges","75% of total billed charges",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",366.74,72,,293.39,,,0,"percent of total billed charges","72% of total billed charges",305.62,60,,244.50,,,0,"percent of total billed charges","60% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",229.21,45,,183.37,,,0,"percent of total billed charges","45% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",509.36,100,,,,,0,"fee schedule","100% CMS fee schedule",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.08,65,,264.86,,,0,"percent of total billed charges","65% of total billed charges",224.63,27,,179.70,,,0,"percent of total billed charges","27% of total billed charges",483.89,95,,387.11,,,0,"percent of total billed charges","95% of total billed charges",509.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",448.24,88,,358.59,,,0,"percent of total billed charges","88% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",224.63,509.36,
"ZOVIRAX 5% CREAM",2720002714,CDM,250,RC,,,Outpatient,,,509.36,254.68,,509.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",387.11,76,,309.69,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",366.74,72,,293.39,,,0,"percent of total billed charges","72% of total billed charges",382.02,75,,305.62,,,0,"percent of total billed charges","75% of total billed charges",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",366.74,72,,293.39,,,0,"percent of total billed charges","72% of total billed charges",305.62,60,,244.50,,,0,"percent of total billed charges","60% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",229.21,45,,183.37,,,0,"percent of total billed charges","45% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",509.36,100,,,,,0,"fee schedule","100% CMS fee schedule",509.36,100,,,,,0,"fee schedule","100% of CMS fee schedule",331.08,65,,264.86,,,0,"percent of total billed charges","65% of total billed charges",224.63,27,,179.70,,,0,"percent of total billed charges","27% of total billed charges",483.89,95,,387.11,,,0,"percent of total billed charges","95% of total billed charges",509.36,75,,,,,0,"fee schedule","75% of CMS fee schedule",448.24,88,,358.59,,,0,"percent of total billed charges","88% of total billed charges",458.42,90,,366.74,,,0,"percent of total billed charges","90% of total billed charges",224.63,509.36,
"IOPIDINE 0.5% OPHTH SOLN",2720002717,CDM,250,RC,,,Outpatient,,,728.75,364.375,,728.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",553.85,76,,443.08,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",524.7,72,,419.76,,,0,"percent of total billed charges","72% of total billed charges",546.56,75,,437.25,,,0,"percent of total billed charges","75% of total billed charges",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",524.7,72,,419.76,,,0,"percent of total billed charges","72% of total billed charges",437.25,60,,349.80,,,0,"percent of total billed charges","60% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",327.94,45,,262.35,,,0,"percent of total billed charges","45% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",728.75,100,,,,,0,"fee schedule","100% CMS fee schedule",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",473.69,65,,378.95,,,0,"percent of total billed charges","65% of total billed charges",321.38,27,,257.10,,,0,"percent of total billed charges","27% of total billed charges",692.31,95,,553.85,,,0,"percent of total billed charges","95% of total billed charges",728.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",641.3,88,,513.04,,,0,"percent of total billed charges","88% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",321.38,728.75,
"IOPIDINE 0.5% OPHTH SOLN",2720002718,CDM,250,RC,,,Outpatient,,,728.75,364.375,,728.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",553.85,76,,443.08,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",524.7,72,,419.76,,,0,"percent of total billed charges","72% of total billed charges",546.56,75,,437.25,,,0,"percent of total billed charges","75% of total billed charges",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",524.7,72,,419.76,,,0,"percent of total billed charges","72% of total billed charges",437.25,60,,349.80,,,0,"percent of total billed charges","60% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",327.94,45,,262.35,,,0,"percent of total billed charges","45% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",728.75,100,,,,,0,"fee schedule","100% CMS fee schedule",728.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",473.69,65,,378.95,,,0,"percent of total billed charges","65% of total billed charges",321.38,27,,257.10,,,0,"percent of total billed charges","27% of total billed charges",692.31,95,,553.85,,,0,"percent of total billed charges","95% of total billed charges",728.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",641.3,88,,513.04,,,0,"percent of total billed charges","88% of total billed charges",655.88,90,,524.70,,,0,"percent of total billed charges","90% of total billed charges",321.38,728.75,
"BUMEX 1MG/4ML INJ",2720002721,CDM,250,RC,J1939,HCPCS,Outpatient,,,11.03,5.515,TB,0.72,100,,,,,0,"fee schedule","100% of CMS OPPS rate",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",0.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1.13,100,,,,,0,"fee schedule","100% of CMS OPPS rate",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",0.43,100,,,,,0,"fee schedule","100% of CMS OPPS rate",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",0.43,10.48,
"BUMEX 1MG/4ML INJ",2720002722,CDM,250,RC,,,Outpatient,,,11.03,5.515,,11.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",8.38,76,,6.70,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",8.27,75,,6.62,,,0,"percent of total billed charges","75% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.94,72,,6.35,,,0,"percent of total billed charges","72% of total billed charges",6.62,60,,5.30,,,0,"percent of total billed charges","60% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.96,45,,3.97,,,0,"percent of total billed charges","45% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% CMS fee schedule",11.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.17,65,,5.74,,,0,"percent of total billed charges","65% of total billed charges",4.86,27,,3.89,,,0,"percent of total billed charges","27% of total billed charges",10.48,95,,8.38,,,0,"percent of total billed charges","95% of total billed charges",11.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",9.71,88,,7.77,,,0,"percent of total billed charges","88% of total billed charges",9.93,90,,7.94,,,0,"percent of total billed charges","90% of total billed charges",4.86,11.03,
"ACULAR 0.5% OPHTH SOLN",2720002725,CDM,250,RC,,,Outpatient,,,334.06,167.03,,334.06,125,,,,,0,"fee schedule","125% of CMS fee schedule",253.89,76,,203.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",240.52,72,,192.42,,,0,"percent of total billed charges","72% of total billed charges",250.55,75,,200.44,,,0,"percent of total billed charges","75% of total billed charges",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",240.52,72,,192.42,,,0,"percent of total billed charges","72% of total billed charges",200.44,60,,160.35,,,0,"percent of total billed charges","60% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",150.33,45,,120.26,,,0,"percent of total billed charges","45% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.06,100,,,,,0,"fee schedule","100% CMS fee schedule",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.14,65,,173.71,,,0,"percent of total billed charges","65% of total billed charges",147.32,27,,117.86,,,0,"percent of total billed charges","27% of total billed charges",317.36,95,,253.89,,,0,"percent of total billed charges","95% of total billed charges",334.06,75,,,,,0,"fee schedule","75% of CMS fee schedule",293.97,88,,235.18,,,0,"percent of total billed charges","88% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",147.32,334.06,
"ACULAR 0.5% OPHTH SOLN",2720002726,CDM,250,RC,,,Outpatient,,,334.06,167.03,,334.06,125,,,,,0,"fee schedule","125% of CMS fee schedule",253.89,76,,203.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",240.52,72,,192.42,,,0,"percent of total billed charges","72% of total billed charges",250.55,75,,200.44,,,0,"percent of total billed charges","75% of total billed charges",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",240.52,72,,192.42,,,0,"percent of total billed charges","72% of total billed charges",200.44,60,,160.35,,,0,"percent of total billed charges","60% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",150.33,45,,120.26,,,0,"percent of total billed charges","45% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",334.06,100,,,,,0,"fee schedule","100% CMS fee schedule",334.06,100,,,,,0,"fee schedule","100% of CMS fee schedule",217.14,65,,173.71,,,0,"percent of total billed charges","65% of total billed charges",147.32,27,,117.86,,,0,"percent of total billed charges","27% of total billed charges",317.36,95,,253.89,,,0,"percent of total billed charges","95% of total billed charges",334.06,75,,,,,0,"fee schedule","75% of CMS fee schedule",293.97,88,,235.18,,,0,"percent of total billed charges","88% of total billed charges",300.65,90,,240.52,,,0,"percent of total billed charges","90% of total billed charges",147.32,334.06,
"LASIX 10MG ORAL SOL",2720002729,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"LASIX 10MG ORAL SOL",2720002730,CDM,250,RC,,,Outpatient,,,38.59,19.295,,38.59,125,,,,,0,"fee schedule","125% of CMS fee schedule",29.33,76,,23.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",28.94,75,,23.15,,,0,"percent of total billed charges","75% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",27.78,72,,22.22,,,0,"percent of total billed charges","72% of total billed charges",23.15,60,,18.52,,,0,"percent of total billed charges","60% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.37,45,,13.90,,,0,"percent of total billed charges","45% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% CMS fee schedule",38.59,100,,,,,0,"fee schedule","100% of CMS fee schedule",25.08,65,,20.06,,,0,"percent of total billed charges","65% of total billed charges",17.02,27,,13.62,,,0,"percent of total billed charges","27% of total billed charges",36.66,95,,29.33,,,0,"percent of total billed charges","95% of total billed charges",38.59,75,,,,,0,"fee schedule","75% of CMS fee schedule",33.96,88,,27.17,,,0,"percent of total billed charges","88% of total billed charges",34.73,90,,27.78,,,0,"percent of total billed charges","90% of total billed charges",17.02,38.59,
"GENTAMICIN 0.1% OINT",2720002733,CDM,250,RC,,,Outpatient,,,276.5,138.25,,276.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",210.14,76,,168.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",199.08,72,,159.26,,,0,"percent of total billed charges","72% of total billed charges",207.38,75,,165.90,,,0,"percent of total billed charges","75% of total billed charges",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.08,72,,159.26,,,0,"percent of total billed charges","72% of total billed charges",165.9,60,,132.72,,,0,"percent of total billed charges","60% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",124.43,45,,99.54,,,0,"percent of total billed charges","45% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.5,100,,,,,0,"fee schedule","100% CMS fee schedule",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.73,65,,143.78,,,0,"percent of total billed charges","65% of total billed charges",121.94,27,,97.55,,,0,"percent of total billed charges","27% of total billed charges",262.68,95,,210.14,,,0,"percent of total billed charges","95% of total billed charges",276.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",243.32,88,,194.66,,,0,"percent of total billed charges","88% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",121.94,276.5,
"GENTAMICIN 0.1% OINT",2720002734,CDM,250,RC,,,Outpatient,,,276.5,138.25,,276.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",210.14,76,,168.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",199.08,72,,159.26,,,0,"percent of total billed charges","72% of total billed charges",207.38,75,,165.90,,,0,"percent of total billed charges","75% of total billed charges",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",199.08,72,,159.26,,,0,"percent of total billed charges","72% of total billed charges",165.9,60,,132.72,,,0,"percent of total billed charges","60% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",124.43,45,,99.54,,,0,"percent of total billed charges","45% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",276.5,100,,,,,0,"fee schedule","100% CMS fee schedule",276.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",179.73,65,,143.78,,,0,"percent of total billed charges","65% of total billed charges",121.94,27,,97.55,,,0,"percent of total billed charges","27% of total billed charges",262.68,95,,210.14,,,0,"percent of total billed charges","95% of total billed charges",276.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",243.32,88,,194.66,,,0,"percent of total billed charges","88% of total billed charges",248.85,90,,199.08,,,0,"percent of total billed charges","90% of total billed charges",121.94,276.5,
"BETAXOLOL 0.25PCT OPHTH SUSP",2720002737,CDM,250,RC,,,Outpatient,,,356.11,178.055,,356.11,125,,,,,0,"fee schedule","125% of CMS fee schedule",270.64,76,,216.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",256.4,72,,205.12,,,0,"percent of total billed charges","72% of total billed charges",267.08,75,,213.66,,,0,"percent of total billed charges","75% of total billed charges",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",256.4,72,,205.12,,,0,"percent of total billed charges","72% of total billed charges",213.67,60,,170.94,,,0,"percent of total billed charges","60% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",160.25,45,,128.20,,,0,"percent of total billed charges","45% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",356.11,100,,,,,0,"fee schedule","100% CMS fee schedule",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",231.47,65,,185.18,,,0,"percent of total billed charges","65% of total billed charges",157.04,27,,125.63,,,0,"percent of total billed charges","27% of total billed charges",338.3,95,,270.64,,,0,"percent of total billed charges","95% of total billed charges",356.11,75,,,,,0,"fee schedule","75% of CMS fee schedule",313.38,88,,250.70,,,0,"percent of total billed charges","88% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",157.04,356.11,
"BETAXOLOL 0.25PCT OPHTH SUSP",2720002738,CDM,250,RC,,,Outpatient,,,356.11,178.055,,356.11,125,,,,,0,"fee schedule","125% of CMS fee schedule",270.64,76,,216.51,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",256.4,72,,205.12,,,0,"percent of total billed charges","72% of total billed charges",267.08,75,,213.66,,,0,"percent of total billed charges","75% of total billed charges",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",256.4,72,,205.12,,,0,"percent of total billed charges","72% of total billed charges",213.67,60,,170.94,,,0,"percent of total billed charges","60% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",160.25,45,,128.20,,,0,"percent of total billed charges","45% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",356.11,100,,,,,0,"fee schedule","100% CMS fee schedule",356.11,100,,,,,0,"fee schedule","100% of CMS fee schedule",231.47,65,,185.18,,,0,"percent of total billed charges","65% of total billed charges",157.04,27,,125.63,,,0,"percent of total billed charges","27% of total billed charges",338.3,95,,270.64,,,0,"percent of total billed charges","95% of total billed charges",356.11,75,,,,,0,"fee schedule","75% of CMS fee schedule",313.38,88,,250.70,,,0,"percent of total billed charges","88% of total billed charges",320.5,90,,256.40,,,0,"percent of total billed charges","90% of total billed charges",157.04,356.11,
"DDAVP SPRAY",2720002741,CDM,250,RC,,,Outpatient,,,997.76,498.88,,997.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",758.3,76,,606.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",718.39,72,,574.71,,,0,"percent of total billed charges","72% of total billed charges",748.32,75,,598.66,,,0,"percent of total billed charges","75% of total billed charges",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",718.39,72,,574.71,,,0,"percent of total billed charges","72% of total billed charges",598.66,60,,478.93,,,0,"percent of total billed charges","60% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",448.99,45,,359.19,,,0,"percent of total billed charges","45% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",997.76,100,,,,,0,"fee schedule","100% CMS fee schedule",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.54,65,,518.83,,,0,"percent of total billed charges","65% of total billed charges",440.01,27,,352.01,,,0,"percent of total billed charges","27% of total billed charges",947.87,95,,758.30,,,0,"percent of total billed charges","95% of total billed charges",997.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",878.03,88,,702.42,,,0,"percent of total billed charges","88% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",440.01,997.76,
"DDAVP SPRAY",2720002742,CDM,250,RC,,,Outpatient,,,997.76,498.88,,997.76,125,,,,,0,"fee schedule","125% of CMS fee schedule",758.3,76,,606.64,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",718.39,72,,574.71,,,0,"percent of total billed charges","72% of total billed charges",748.32,75,,598.66,,,0,"percent of total billed charges","75% of total billed charges",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",718.39,72,,574.71,,,0,"percent of total billed charges","72% of total billed charges",598.66,60,,478.93,,,0,"percent of total billed charges","60% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",448.99,45,,359.19,,,0,"percent of total billed charges","45% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",997.76,100,,,,,0,"fee schedule","100% CMS fee schedule",997.76,100,,,,,0,"fee schedule","100% of CMS fee schedule",648.54,65,,518.83,,,0,"percent of total billed charges","65% of total billed charges",440.01,27,,352.01,,,0,"percent of total billed charges","27% of total billed charges",947.87,95,,758.30,,,0,"percent of total billed charges","95% of total billed charges",997.76,75,,,,,0,"fee schedule","75% of CMS fee schedule",878.03,88,,702.42,,,0,"percent of total billed charges","88% of total billed charges",897.98,90,,718.38,,,0,"percent of total billed charges","90% of total billed charges",440.01,997.76,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002745,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002746,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"COMPAZINE 25MG SUPP",2720002749,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"COMPAZINE 25MG SUPP",2720002750,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"PHENERGAN 25MG TABS S 4",2720002753,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PHENERGAN 25MG TABS S 4",2720002754,CDM,250,RC,,,Outpatient,,,13.23,6.615,,13.23,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.05,76,,8.04,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",9.92,75,,7.94,,,0,"percent of total billed charges","75% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.53,72,,7.62,,,0,"percent of total billed charges","72% of total billed charges",7.94,60,,6.35,,,0,"percent of total billed charges","60% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.95,45,,4.76,,,0,"percent of total billed charges","45% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% CMS fee schedule",13.23,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.6,65,,6.88,,,0,"percent of total billed charges","65% of total billed charges",5.83,27,,4.66,,,0,"percent of total billed charges","27% of total billed charges",12.57,95,,10.06,,,0,"percent of total billed charges","95% of total billed charges",13.23,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.64,88,,9.31,,,0,"percent of total billed charges","88% of total billed charges",11.91,90,,9.53,,,0,"percent of total billed charges","90% of total billed charges",5.83,13.23,
"PROMETHAZINE 6.25MG/5ML SYRUP",2720002757,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"PROMETHAZINE 6.25MG/5ML SYRUP",2720002758,CDM,250,RC,,,Outpatient,,,2.21,1.105,,2.21,125,,,,,0,"fee schedule","125% of CMS fee schedule",1.68,76,,1.34,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.66,75,,1.33,,,0,"percent of total billed charges","75% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.59,72,,1.27,,,0,"percent of total billed charges","72% of total billed charges",1.33,60,,1.06,,,0,"percent of total billed charges","60% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.99,45,,0.79,,,0,"percent of total billed charges","45% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% CMS fee schedule",2.21,100,,,,,0,"fee schedule","100% of CMS fee schedule",1.44,65,,1.15,,,0,"percent of total billed charges","65% of total billed charges",0.97,27,,0.78,,,0,"percent of total billed charges","27% of total billed charges",2.1,95,,1.68,,,0,"percent of total billed charges","95% of total billed charges",2.21,75,,,,,0,"fee schedule","75% of CMS fee schedule",1.94,88,,1.55,,,0,"percent of total billed charges","88% of total billed charges",1.99,90,,1.59,,,0,"percent of total billed charges","90% of total billed charges",0.97,2.21,
"MITOMYCIN 20MG INJ",2720002761,CDM,250,RC,,,Outpatient,,,998.87,499.435,,998.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",759.14,76,,607.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",719.19,72,,575.35,,,0,"percent of total billed charges","72% of total billed charges",749.15,75,,599.32,,,0,"percent of total billed charges","75% of total billed charges",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",719.19,72,,575.35,,,0,"percent of total billed charges","72% of total billed charges",599.32,60,,479.46,,,0,"percent of total billed charges","60% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",449.49,45,,359.59,,,0,"percent of total billed charges","45% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",998.87,100,,,,,0,"fee schedule","100% CMS fee schedule",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",649.27,65,,519.42,,,0,"percent of total billed charges","65% of total billed charges",440.5,27,,352.40,,,0,"percent of total billed charges","27% of total billed charges",948.93,95,,759.14,,,0,"percent of total billed charges","95% of total billed charges",998.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",879.01,88,,703.21,,,0,"percent of total billed charges","88% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",440.5,998.87,
"MITOMYCIN 20MG INJ",2720002762,CDM,250,RC,,,Outpatient,,,998.87,499.435,,998.87,125,,,,,0,"fee schedule","125% of CMS fee schedule",759.14,76,,607.31,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",719.19,72,,575.35,,,0,"percent of total billed charges","72% of total billed charges",749.15,75,,599.32,,,0,"percent of total billed charges","75% of total billed charges",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",719.19,72,,575.35,,,0,"percent of total billed charges","72% of total billed charges",599.32,60,,479.46,,,0,"percent of total billed charges","60% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",449.49,45,,359.59,,,0,"percent of total billed charges","45% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",998.87,100,,,,,0,"fee schedule","100% CMS fee schedule",998.87,100,,,,,0,"fee schedule","100% of CMS fee schedule",649.27,65,,519.42,,,0,"percent of total billed charges","65% of total billed charges",440.5,27,,352.40,,,0,"percent of total billed charges","27% of total billed charges",948.93,95,,759.14,,,0,"percent of total billed charges","95% of total billed charges",998.87,75,,,,,0,"fee schedule","75% of CMS fee schedule",879.01,88,,703.21,,,0,"percent of total billed charges","88% of total billed charges",898.98,90,,719.18,,,0,"percent of total billed charges","90% of total billed charges",440.5,998.87,
"RETROVIR 200MG/20 ML INJ",2720002765,CDM,250,RC,J3485,HCPCS,Outpatient,,,159.86,79.93,U8,159.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",121.49,76,,97.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.11,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.11,350,,,,,0,"fee schedule","350% of BCBS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.46,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",71.94,45,,57.55,,,0,"percent of total billed charges","45% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.91,65,,83.13,,,0,"percent of total billed charges","65% of total billed charges",70.5,27,,56.40,,,0,"percent of total billed charges","27% of total billed charges",151.87,95,,121.50,,,0,"percent of total billed charges","95% of total billed charges",159.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",140.68,88,,112.54,,,0,"percent of total billed charges","88% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",1.46,159.86,
"RETROVIR 200MG/20 ML INJ",2720002766,CDM,250,RC,J3485,HCPCS,Outpatient,,,159.86,79.93,U8,159.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",121.49,76,,97.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5.11,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",5.11,350,,,,,0,"fee schedule","350% of BCBS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.11,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",1.46,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",71.94,45,,57.55,,,0,"percent of total billed charges","45% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.91,65,,83.13,,,0,"percent of total billed charges","65% of total billed charges",70.5,27,,56.40,,,0,"percent of total billed charges","27% of total billed charges",151.87,95,,121.50,,,0,"percent of total billed charges","95% of total billed charges",159.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",140.68,88,,112.54,,,0,"percent of total billed charges","88% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",1.46,159.86,
"CRESTOR 10MG TAB",2720002769,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"CRESTOR 10MG TAB",2720002770,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"PEN-VEE 250MG/5ML SUSP 100ML",2720002773,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"PEN-VEE 250MG/5ML SUSP 100ML",2720002774,CDM,250,RC,,,Outpatient,,,34.18,17.09,,34.18,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.98,76,,20.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",25.64,75,,20.51,,,0,"percent of total billed charges","75% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.61,72,,19.69,,,0,"percent of total billed charges","72% of total billed charges",20.51,60,,16.41,,,0,"percent of total billed charges","60% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.38,45,,12.30,,,0,"percent of total billed charges","45% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% CMS fee schedule",34.18,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.22,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.07,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.47,95,,25.98,,,0,"percent of total billed charges","95% of total billed charges",34.18,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.08,88,,24.06,,,0,"percent of total billed charges","88% of total billed charges",30.76,90,,24.61,,,0,"percent of total billed charges","90% of total billed charges",15.07,34.18,
"NEOSPORIN OPHTH SOL S 10ML",2720002777,CDM,250,RC,,,Outpatient,,,146.63,73.315,,146.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",111.44,76,,89.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",109.97,75,,87.98,,,0,"percent of total billed charges","75% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",87.98,60,,70.38,,,0,"percent of total billed charges","60% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",65.98,45,,52.78,,,0,"percent of total billed charges","45% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.31,65,,76.25,,,0,"percent of total billed charges","65% of total billed charges",64.66,27,,51.73,,,0,"percent of total billed charges","27% of total billed charges",139.3,95,,111.44,,,0,"percent of total billed charges","95% of total billed charges",146.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",129.03,88,,103.22,,,0,"percent of total billed charges","88% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",64.66,146.63,
"NEOSPORIN OPHTH SOL S 10ML",2720002778,CDM,250,RC,,,Outpatient,,,146.63,73.315,,146.63,125,,,,,0,"fee schedule","125% of CMS fee schedule",111.44,76,,89.15,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",109.97,75,,87.98,,,0,"percent of total billed charges","75% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",105.57,72,,84.46,,,0,"percent of total billed charges","72% of total billed charges",87.98,60,,70.38,,,0,"percent of total billed charges","60% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",65.98,45,,52.78,,,0,"percent of total billed charges","45% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% CMS fee schedule",146.63,100,,,,,0,"fee schedule","100% of CMS fee schedule",95.31,65,,76.25,,,0,"percent of total billed charges","65% of total billed charges",64.66,27,,51.73,,,0,"percent of total billed charges","27% of total billed charges",139.3,95,,111.44,,,0,"percent of total billed charges","95% of total billed charges",146.63,75,,,,,0,"fee schedule","75% of CMS fee schedule",129.03,88,,103.22,,,0,"percent of total billed charges","88% of total billed charges",131.97,90,,105.58,,,0,"percent of total billed charges","90% of total billed charges",64.66,146.63,
"TETRACAINE 1% OPHTH",2720002781,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"TETRACAINE 1% OPHTH",2720002782,CDM,250,RC,,,Outpatient,,,24.26,12.13,,24.26,125,,,,,0,"fee schedule","125% of CMS fee schedule",18.44,76,,14.75,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",18.2,75,,14.56,,,0,"percent of total billed charges","75% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.47,72,,13.98,,,0,"percent of total billed charges","72% of total billed charges",14.56,60,,11.65,,,0,"percent of total billed charges","60% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.92,45,,8.74,,,0,"percent of total billed charges","45% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% CMS fee schedule",24.26,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.77,65,,12.62,,,0,"percent of total billed charges","65% of total billed charges",10.7,27,,8.56,,,0,"percent of total billed charges","27% of total billed charges",23.05,95,,18.44,,,0,"percent of total billed charges","95% of total billed charges",24.26,75,,,,,0,"fee schedule","75% of CMS fee schedule",21.35,88,,17.08,,,0,"percent of total billed charges","88% of total billed charges",21.83,90,,17.46,,,0,"percent of total billed charges","90% of total billed charges",10.7,24.26,
"LIDO W/EPI 1PCT 20ML INJ",2720002785,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LIDO W/EPI 1PCT 20ML INJ",2720002786,CDM,250,RC,,,Outpatient,,,12.13,6.065,,12.13,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.22,76,,7.38,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",9.1,75,,7.28,,,0,"percent of total billed charges","75% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.73,72,,6.98,,,0,"percent of total billed charges","72% of total billed charges",7.28,60,,5.82,,,0,"percent of total billed charges","60% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.46,45,,4.37,,,0,"percent of total billed charges","45% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% CMS fee schedule",12.13,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.88,65,,6.30,,,0,"percent of total billed charges","65% of total billed charges",5.35,27,,4.28,,,0,"percent of total billed charges","27% of total billed charges",11.52,95,,9.22,,,0,"percent of total billed charges","95% of total billed charges",12.13,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.67,88,,8.54,,,0,"percent of total billed charges","88% of total billed charges",10.92,90,,8.74,,,0,"percent of total billed charges","90% of total billed charges",5.35,12.13,
"LIDO 1% W/EPI 30ML INJ",2720002789,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"LIDO 1% W/EPI 30ML INJ",2720002790,CDM,250,RC,,,Outpatient,,,12,6,,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,7.30,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,7.20,,,0,"percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,4.23,,,0,"percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,,,0,"percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"MAXZIDE 75/50 TAB",2720002793,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MAXZIDE 75/50 TAB",2720002794,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"LEVSIN DROPS",2720002797,CDM,250,RC,,,Outpatient,,,159.86,79.93,,159.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",121.49,76,,97.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",115.1,72,,92.08,,,0,"percent of total billed charges","72% of total billed charges",119.9,75,,95.92,,,0,"percent of total billed charges","75% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.1,72,,92.08,,,0,"percent of total billed charges","72% of total billed charges",95.92,60,,76.74,,,0,"percent of total billed charges","60% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",71.94,45,,57.55,,,0,"percent of total billed charges","45% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.91,65,,83.13,,,0,"percent of total billed charges","65% of total billed charges",70.5,27,,56.40,,,0,"percent of total billed charges","27% of total billed charges",151.87,95,,121.50,,,0,"percent of total billed charges","95% of total billed charges",159.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",140.68,88,,112.54,,,0,"percent of total billed charges","88% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",70.5,159.86,
"LEVSIN DROPS",2720002798,CDM,250,RC,,,Outpatient,,,159.86,79.93,,159.86,125,,,,,0,"fee schedule","125% of CMS fee schedule",121.49,76,,97.19,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",115.1,72,,92.08,,,0,"percent of total billed charges","72% of total billed charges",119.9,75,,95.92,,,0,"percent of total billed charges","75% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",115.1,72,,92.08,,,0,"percent of total billed charges","72% of total billed charges",95.92,60,,76.74,,,0,"percent of total billed charges","60% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",71.94,45,,57.55,,,0,"percent of total billed charges","45% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% CMS fee schedule",159.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.91,65,,83.13,,,0,"percent of total billed charges","65% of total billed charges",70.5,27,,56.40,,,0,"percent of total billed charges","27% of total billed charges",151.87,95,,121.50,,,0,"percent of total billed charges","95% of total billed charges",159.86,75,,,,,0,"fee schedule","75% of CMS fee schedule",140.68,88,,112.54,,,0,"percent of total billed charges","88% of total billed charges",143.87,90,,115.10,,,0,"percent of total billed charges","90% of total billed charges",70.5,159.86,
"ZYVOX 600MG TAB",2720002801,CDM,250,RC,,,Outpatient,,,446.51,223.255,,446.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",339.35,76,,271.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",321.49,72,,257.19,,,0,"percent of total billed charges","72% of total billed charges",334.88,75,,267.90,,,0,"percent of total billed charges","75% of total billed charges",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",321.49,72,,257.19,,,0,"percent of total billed charges","72% of total billed charges",267.91,60,,214.33,,,0,"percent of total billed charges","60% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",200.93,45,,160.74,,,0,"percent of total billed charges","45% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",446.51,100,,,,,0,"fee schedule","100% CMS fee schedule",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",290.23,65,,232.18,,,0,"percent of total billed charges","65% of total billed charges",196.91,27,,157.53,,,0,"percent of total billed charges","27% of total billed charges",424.18,95,,339.34,,,0,"percent of total billed charges","95% of total billed charges",446.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",392.93,88,,314.34,,,0,"percent of total billed charges","88% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",196.91,446.51,
"ZYVOX 600MG TAB",2720002802,CDM,250,RC,,,Outpatient,,,446.51,223.255,,446.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",339.35,76,,271.48,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",321.49,72,,257.19,,,0,"percent of total billed charges","72% of total billed charges",334.88,75,,267.90,,,0,"percent of total billed charges","75% of total billed charges",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",321.49,72,,257.19,,,0,"percent of total billed charges","72% of total billed charges",267.91,60,,214.33,,,0,"percent of total billed charges","60% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",200.93,45,,160.74,,,0,"percent of total billed charges","45% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",446.51,100,,,,,0,"fee schedule","100% CMS fee schedule",446.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",290.23,65,,232.18,,,0,"percent of total billed charges","65% of total billed charges",196.91,27,,157.53,,,0,"percent of total billed charges","27% of total billed charges",424.18,95,,339.34,,,0,"percent of total billed charges","95% of total billed charges",446.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",392.93,88,,314.34,,,0,"percent of total billed charges","88% of total billed charges",401.86,90,,321.49,,,0,"percent of total billed charges","90% of total billed charges",196.91,446.51,
"MAGNESIUM SULF 1GM/2ML INJ",2720002805,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"MAGNESIUM SULF 1GM/2ML INJ",2720002806,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"OCUFLOX 03% OPHTH SOLN",2720002809,CDM,250,RC,,,Outpatient,,,251.37,125.685,,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",188.53,75,,150.82,,,0,"percent of total billed charges","75% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",150.82,60,,120.66,,,0,"percent of total billed charges","60% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,176.97,,,0,"percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",110.85,251.37,
"OCUFLOX 03% OPHTH SOLN",2720002810,CDM,250,RC,,,Outpatient,,,251.37,125.685,,251.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",191.04,76,,152.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",188.53,75,,150.82,,,0,"percent of total billed charges","75% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",180.99,72,,144.79,,,0,"percent of total billed charges","72% of total billed charges",150.82,60,,120.66,,,0,"percent of total billed charges","60% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",113.12,45,,90.50,,,0,"percent of total billed charges","45% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% CMS fee schedule",251.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",163.39,65,,130.71,,,0,"percent of total billed charges","65% of total billed charges",110.85,27,,88.68,,,0,"percent of total billed charges","27% of total billed charges",238.8,95,,191.04,,,0,"percent of total billed charges","95% of total billed charges",251.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",221.21,88,,176.97,,,0,"percent of total billed charges","88% of total billed charges",226.23,90,,180.98,,,0,"percent of total billed charges","90% of total billed charges",110.85,251.37,
"TALWIN 50MG TAB",2720002813,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"TALWIN 50MG TAB",2720002814,CDM,250,RC,,,Outpatient,,,8.82,4.41,,8.82,125,,,,,0,"fee schedule","125% of CMS fee schedule",6.7,76,,5.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",6.62,75,,5.30,,,0,"percent of total billed charges","75% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.35,72,,5.08,,,0,"percent of total billed charges","72% of total billed charges",5.29,60,,4.23,,,0,"percent of total billed charges","60% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.97,45,,3.18,,,0,"percent of total billed charges","45% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% CMS fee schedule",8.82,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.73,65,,4.58,,,0,"percent of total billed charges","65% of total billed charges",3.89,27,,3.11,,,0,"percent of total billed charges","27% of total billed charges",8.38,95,,6.70,,,0,"percent of total billed charges","95% of total billed charges",8.82,75,,,,,0,"fee schedule","75% of CMS fee schedule",7.76,88,,6.21,,,0,"percent of total billed charges","88% of total billed charges",7.94,90,,6.35,,,0,"percent of total billed charges","90% of total billed charges",3.89,8.82,
"PILOCAR 4% OPHTH SOLN",2720002817,CDM,250,RC,,,Outpatient,,,234.83,117.415,,234.83,125,,,,,0,"fee schedule","125% of CMS fee schedule",178.47,76,,142.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",169.08,72,,135.26,,,0,"percent of total billed charges","72% of total billed charges",176.12,75,,140.90,,,0,"percent of total billed charges","75% of total billed charges",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.08,72,,135.26,,,0,"percent of total billed charges","72% of total billed charges",140.9,60,,112.72,,,0,"percent of total billed charges","60% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",105.67,45,,84.54,,,0,"percent of total billed charges","45% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.83,100,,,,,0,"fee schedule","100% CMS fee schedule",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",152.64,65,,122.11,,,0,"percent of total billed charges","65% of total billed charges",103.56,27,,82.85,,,0,"percent of total billed charges","27% of total billed charges",223.09,95,,178.47,,,0,"percent of total billed charges","95% of total billed charges",234.83,75,,,,,0,"fee schedule","75% of CMS fee schedule",206.65,88,,165.32,,,0,"percent of total billed charges","88% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",103.56,234.83,
"PILOCAR 4% OPHTH SOLN",2720002820,CDM,250,RC,,,Outpatient,,,234.83,117.415,,234.83,125,,,,,0,"fee schedule","125% of CMS fee schedule",178.47,76,,142.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",169.08,72,,135.26,,,0,"percent of total billed charges","72% of total billed charges",176.12,75,,140.90,,,0,"percent of total billed charges","75% of total billed charges",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.08,72,,135.26,,,0,"percent of total billed charges","72% of total billed charges",140.9,60,,112.72,,,0,"percent of total billed charges","60% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",105.67,45,,84.54,,,0,"percent of total billed charges","45% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",234.83,100,,,,,0,"fee schedule","100% CMS fee schedule",234.83,100,,,,,0,"fee schedule","100% of CMS fee schedule",152.64,65,,122.11,,,0,"percent of total billed charges","65% of total billed charges",103.56,27,,82.85,,,0,"percent of total billed charges","27% of total billed charges",223.09,95,,178.47,,,0,"percent of total billed charges","95% of total billed charges",234.83,75,,,,,0,"fee schedule","75% of CMS fee schedule",206.65,88,,165.32,,,0,"percent of total billed charges","88% of total billed charges",211.35,90,,169.08,,,0,"percent of total billed charges","90% of total billed charges",103.56,234.83,
"COMPAZINE 10MG TAB",2720002823,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"COMPAZINE 10MG TAB",2720002824,CDM,250,RC,,,Outpatient,,,5.51,2.755,,5.51,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.19,76,,3.35,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",4.13,75,,3.30,,,0,"percent of total billed charges","75% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.97,72,,3.18,,,0,"percent of total billed charges","72% of total billed charges",3.31,60,,2.65,,,0,"percent of total billed charges","60% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.48,45,,1.98,,,0,"percent of total billed charges","45% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% CMS fee schedule",5.51,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.58,65,,2.86,,,0,"percent of total billed charges","65% of total billed charges",2.43,27,,1.94,,,0,"percent of total billed charges","27% of total billed charges",5.23,95,,4.18,,,0,"percent of total billed charges","95% of total billed charges",5.51,75,,,,,0,"fee schedule","75% of CMS fee schedule",4.85,88,,3.88,,,0,"percent of total billed charges","88% of total billed charges",4.96,90,,3.97,,,0,"percent of total billed charges","90% of total billed charges",2.43,5.51,
"QUINIDINE 324MG TAB",2720002827,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"QUINIDINE 324MG TAB",2720002828,CDM,250,RC,,,Outpatient,,,6.62,3.31,,6.62,125,,,,,0,"fee schedule","125% of CMS fee schedule",5.03,76,,4.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",4.97,75,,3.98,,,0,"percent of total billed charges","75% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.77,72,,3.82,,,0,"percent of total billed charges","72% of total billed charges",3.97,60,,3.18,,,0,"percent of total billed charges","60% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.98,45,,2.38,,,0,"percent of total billed charges","45% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% CMS fee schedule",6.62,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.3,65,,3.44,,,0,"percent of total billed charges","65% of total billed charges",2.92,27,,2.34,,,0,"percent of total billed charges","27% of total billed charges",6.29,95,,5.03,,,0,"percent of total billed charges","95% of total billed charges",6.62,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.83,88,,4.66,,,0,"percent of total billed charges","88% of total billed charges",5.96,90,,4.77,,,0,"percent of total billed charges","90% of total billed charges",2.92,6.62,
"NAROPIN 2MG/ML 200ML",2720002831,CDM,250,RC,,,Outpatient,,,261.29,130.645,,261.29,125,,,,,0,"fee schedule","125% of CMS fee schedule",198.58,76,,158.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.13,72,,150.50,,,0,"percent of total billed charges","72% of total billed charges",195.97,75,,156.78,,,0,"percent of total billed charges","75% of total billed charges",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.13,72,,150.50,,,0,"percent of total billed charges","72% of total billed charges",156.77,60,,125.42,,,0,"percent of total billed charges","60% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",117.58,45,,94.06,,,0,"percent of total billed charges","45% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",261.29,100,,,,,0,"fee schedule","100% CMS fee schedule",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.84,65,,135.87,,,0,"percent of total billed charges","65% of total billed charges",115.23,27,,92.18,,,0,"percent of total billed charges","27% of total billed charges",248.23,95,,198.58,,,0,"percent of total billed charges","95% of total billed charges",261.29,75,,,,,0,"fee schedule","75% of CMS fee schedule",229.94,88,,183.95,,,0,"percent of total billed charges","88% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",115.23,261.29,
"NAROPIN 2MG/ML 200ML",2720002832,CDM,250,RC,,,Outpatient,,,261.29,130.645,,261.29,125,,,,,0,"fee schedule","125% of CMS fee schedule",198.58,76,,158.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",188.13,72,,150.50,,,0,"percent of total billed charges","72% of total billed charges",195.97,75,,156.78,,,0,"percent of total billed charges","75% of total billed charges",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",188.13,72,,150.50,,,0,"percent of total billed charges","72% of total billed charges",156.77,60,,125.42,,,0,"percent of total billed charges","60% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",117.58,45,,94.06,,,0,"percent of total billed charges","45% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",261.29,100,,,,,0,"fee schedule","100% CMS fee schedule",261.29,100,,,,,0,"fee schedule","100% of CMS fee schedule",169.84,65,,135.87,,,0,"percent of total billed charges","65% of total billed charges",115.23,27,,92.18,,,0,"percent of total billed charges","27% of total billed charges",248.23,95,,198.58,,,0,"percent of total billed charges","95% of total billed charges",261.29,75,,,,,0,"fee schedule","75% of CMS fee schedule",229.94,88,,183.95,,,0,"percent of total billed charges","88% of total billed charges",235.16,90,,188.13,,,0,"percent of total billed charges","90% of total billed charges",115.23,261.29,
"MURO 128 2% OPHTH SOLN",2720002835,CDM,250,RC,,,Outpatient,,,83.79,41.895,,83.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",63.68,76,,50.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",62.84,75,,50.27,,,0,"percent of total billed charges","75% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",50.27,60,,40.22,,,0,"percent of total billed charges","60% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",37.71,45,,30.17,,,0,"percent of total billed charges","45% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.46,65,,43.57,,,0,"percent of total billed charges","65% of total billed charges",36.95,27,,29.56,,,0,"percent of total billed charges","27% of total billed charges",79.6,95,,63.68,,,0,"percent of total billed charges","95% of total billed charges",83.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",73.74,88,,58.99,,,0,"percent of total billed charges","88% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",36.95,83.79,
"MURO 128 2% OPHTH SOLN",2720002836,CDM,250,RC,,,Outpatient,,,83.79,41.895,,83.79,125,,,,,0,"fee schedule","125% of CMS fee schedule",63.68,76,,50.94,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",62.84,75,,50.27,,,0,"percent of total billed charges","75% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",60.33,72,,48.26,,,0,"percent of total billed charges","72% of total billed charges",50.27,60,,40.22,,,0,"percent of total billed charges","60% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",37.71,45,,30.17,,,0,"percent of total billed charges","45% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% CMS fee schedule",83.79,100,,,,,0,"fee schedule","100% of CMS fee schedule",54.46,65,,43.57,,,0,"percent of total billed charges","65% of total billed charges",36.95,27,,29.56,,,0,"percent of total billed charges","27% of total billed charges",79.6,95,,63.68,,,0,"percent of total billed charges","95% of total billed charges",83.79,75,,,,,0,"fee schedule","75% of CMS fee schedule",73.74,88,,58.99,,,0,"percent of total billed charges","88% of total billed charges",75.41,90,,60.33,,,0,"percent of total billed charges","90% of total billed charges",36.95,83.79,
"THEOPHYLL 100MG TAB",2720002839,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"THEOPHYLL 100MG TAB",2720002840,CDM,250,RC,,,Outpatient,,,3.31,1.655,,3.31,125,,,,,0,"fee schedule","125% of CMS fee schedule",2.52,76,,2.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",2.48,75,,1.98,,,0,"percent of total billed charges","75% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.38,72,,1.90,,,0,"percent of total billed charges","72% of total billed charges",1.99,60,,1.59,,,0,"percent of total billed charges","60% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.49,45,,1.19,,,0,"percent of total billed charges","45% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% CMS fee schedule",3.31,100,,,,,0,"fee schedule","100% of CMS fee schedule",2.15,65,,1.72,,,0,"percent of total billed charges","65% of total billed charges",1.46,27,,1.17,,,0,"percent of total billed charges","27% of total billed charges",3.14,95,,2.51,,,0,"percent of total billed charges","95% of total billed charges",3.31,75,,,,,0,"fee schedule","75% of CMS fee schedule",2.91,88,,2.33,,,0,"percent of total billed charges","88% of total billed charges",2.98,90,,2.38,,,0,"percent of total billed charges","90% of total billed charges",1.46,3.31,
"TIMOLOL 0.5PCT SOL-G OPHTH",2720002843,CDM,250,RC,,,Outpatient,,,544.64,272.32,,544.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",413.93,76,,331.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",392.14,72,,313.71,,,0,"percent of total billed charges","72% of total billed charges",408.48,75,,326.78,,,0,"percent of total billed charges","75% of total billed charges",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",392.14,72,,313.71,,,0,"percent of total billed charges","72% of total billed charges",326.78,60,,261.42,,,0,"percent of total billed charges","60% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",245.09,45,,196.07,,,0,"percent of total billed charges","45% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",544.64,100,,,,,0,"fee schedule","100% CMS fee schedule",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",354.02,65,,283.22,,,0,"percent of total billed charges","65% of total billed charges",240.19,27,,192.15,,,0,"percent of total billed charges","27% of total billed charges",517.41,95,,413.93,,,0,"percent of total billed charges","95% of total billed charges",544.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",479.28,88,,383.42,,,0,"percent of total billed charges","88% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",240.19,544.64,
"TIMOLOL 0.5PCT SOL-G OPHTH",2720002844,CDM,250,RC,,,Outpatient,,,544.64,272.32,,544.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",413.93,76,,331.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",392.14,72,,313.71,,,0,"percent of total billed charges","72% of total billed charges",408.48,75,,326.78,,,0,"percent of total billed charges","75% of total billed charges",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",392.14,72,,313.71,,,0,"percent of total billed charges","72% of total billed charges",326.78,60,,261.42,,,0,"percent of total billed charges","60% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",245.09,45,,196.07,,,0,"percent of total billed charges","45% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",544.64,100,,,,,0,"fee schedule","100% CMS fee schedule",544.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",354.02,65,,283.22,,,0,"percent of total billed charges","65% of total billed charges",240.19,27,,192.15,,,0,"percent of total billed charges","27% of total billed charges",517.41,95,,413.93,,,0,"percent of total billed charges","95% of total billed charges",544.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",479.28,88,,383.42,,,0,"percent of total billed charges","88% of total billed charges",490.18,90,,392.14,,,0,"percent of total billed charges","90% of total billed charges",240.19,544.64,
"VIROPTIC 1% OPHTH SOLN",2720002847,CDM,250,RC,,,Outpatient,,,681.35,340.675,,681.35,125,,,,,0,"fee schedule","125% of CMS fee schedule",517.83,76,,414.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",490.57,72,,392.46,,,0,"percent of total billed charges","72% of total billed charges",511.01,75,,408.81,,,0,"percent of total billed charges","75% of total billed charges",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",490.57,72,,392.46,,,0,"percent of total billed charges","72% of total billed charges",408.81,60,,327.05,,,0,"percent of total billed charges","60% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",306.61,45,,245.29,,,0,"percent of total billed charges","45% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",681.35,100,,,,,0,"fee schedule","100% CMS fee schedule",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",442.88,65,,354.30,,,0,"percent of total billed charges","65% of total billed charges",300.48,27,,240.38,,,0,"percent of total billed charges","27% of total billed charges",647.28,95,,517.82,,,0,"percent of total billed charges","95% of total billed charges",681.35,75,,,,,0,"fee schedule","75% of CMS fee schedule",599.59,88,,479.67,,,0,"percent of total billed charges","88% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",300.48,681.35,
"VIROPTIC 1% OPHTH SOLN",2720002848,CDM,250,RC,,,Outpatient,,,681.35,340.675,,681.35,125,,,,,0,"fee schedule","125% of CMS fee schedule",517.83,76,,414.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",490.57,72,,392.46,,,0,"percent of total billed charges","72% of total billed charges",511.01,75,,408.81,,,0,"percent of total billed charges","75% of total billed charges",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",490.57,72,,392.46,,,0,"percent of total billed charges","72% of total billed charges",408.81,60,,327.05,,,0,"percent of total billed charges","60% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",306.61,45,,245.29,,,0,"percent of total billed charges","45% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",681.35,100,,,,,0,"fee schedule","100% CMS fee schedule",681.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",442.88,65,,354.30,,,0,"percent of total billed charges","65% of total billed charges",300.48,27,,240.38,,,0,"percent of total billed charges","27% of total billed charges",647.28,95,,517.82,,,0,"percent of total billed charges","95% of total billed charges",681.35,75,,,,,0,"fee schedule","75% of CMS fee schedule",599.59,88,,479.67,,,0,"percent of total billed charges","88% of total billed charges",613.22,90,,490.58,,,0,"percent of total billed charges","90% of total billed charges",300.48,681.35,
"STROMECTOL 3MG",2720002851,CDM,250,RC,,,Outpatient,,,16.5,8.25,,16.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.54,76,,10.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.88,72,,9.50,,,0,"percent of total billed charges","72% of total billed charges",12.38,75,,9.90,,,0,"percent of total billed charges","75% of total billed charges",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.88,72,,9.50,,,0,"percent of total billed charges","72% of total billed charges",9.9,60,,7.92,,,0,"percent of total billed charges","60% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",7.43,45,,5.94,,,0,"percent of total billed charges","45% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.5,100,,,,,0,"fee schedule","100% CMS fee schedule",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.73,65,,8.58,,,0,"percent of total billed charges","65% of total billed charges",7.28,27,,5.82,,,0,"percent of total billed charges","27% of total billed charges",15.68,95,,12.54,,,0,"percent of total billed charges","95% of total billed charges",16.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.52,88,,11.62,,,0,"percent of total billed charges","88% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",7.28,16.5,
"STROMECTOL 3MG",2720002852,CDM,250,RC,,,Outpatient,,,16.5,8.25,,16.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.54,76,,10.03,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.88,72,,9.50,,,0,"percent of total billed charges","72% of total billed charges",12.38,75,,9.90,,,0,"percent of total billed charges","75% of total billed charges",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.88,72,,9.50,,,0,"percent of total billed charges","72% of total billed charges",9.9,60,,7.92,,,0,"percent of total billed charges","60% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",7.43,45,,5.94,,,0,"percent of total billed charges","45% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.5,100,,,,,0,"fee schedule","100% CMS fee schedule",16.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.73,65,,8.58,,,0,"percent of total billed charges","65% of total billed charges",7.28,27,,5.82,,,0,"percent of total billed charges","27% of total billed charges",15.68,95,,12.54,,,0,"percent of total billed charges","95% of total billed charges",16.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.52,88,,11.62,,,0,"percent of total billed charges","88% of total billed charges",14.85,90,,11.88,,,0,"percent of total billed charges","90% of total billed charges",7.28,16.5,
"SILDENAFIL 20MG TAB",2720002883,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"SILDENAFIL 20MG TAB",2720002884,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"BUPIVACAINE 0.5% 10ML",2720002887,CDM,250,RC,J0665,HCPCS,Outpatient,,,12,6,U8,12,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.12,76,,0.05,0.05,0.05,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",9,75,,0.06,0.02,0.12,"1 through 10","percent of total billed charges","75% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.64,72,,6.91,,,0,"percent of total billed charges","72% of total billed charges",7.2,60,,5.76,,,0,"percent of total billed charges","60% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.4,45,,4.32,,,0,"percent of total billed charges","45% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",12,100,,,,,0,"fee schedule","100% of CMS fee schedule",12,100,,,,,0,"fee schedule","100% CMS fee schedule",12,100,,0.05,0.05,0.05,"1 through 10","fee schedule","100% of CMS fee schedule",7.8,65,,6.24,,,0,"percent of total billed charges","65% of total billed charges",5.29,27,,81.01,81.01,81.01,"1 through 10","percent of total billed charges","27% of total billed charges",11.4,95,,9.12,,,0,"percent of total billed charges","95% of total billed charges",12,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.56,88,,8.45,8.45,8.45,"1 through 10","percent of total billed charges","88% of total billed charges",10.8,90,,8.64,,,0,"percent of total billed charges","90% of total billed charges",5.29,12,
"METHOTREXATE 125MG/5ML INJ",2720002891,CDM,250,RC,,,Outpatient,,,987.5,493.75,,987.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",750.5,76,,600.40,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",711,72,,568.80,,,0,"percent of total billed charges","72% of total billed charges",740.63,75,,592.50,,,0,"percent of total billed charges","75% of total billed charges",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",711,72,,568.80,,,0,"percent of total billed charges","72% of total billed charges",592.5,60,,474.00,,,0,"percent of total billed charges","60% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",444.38,45,,355.50,,,0,"percent of total billed charges","45% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",987.5,100,,,,,0,"fee schedule","100% CMS fee schedule",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",641.88,65,,513.50,,,0,"percent of total billed charges","65% of total billed charges",435.49,27,,348.39,,,0,"percent of total billed charges","27% of total billed charges",938.13,95,,750.50,,,0,"percent of total billed charges","95% of total billed charges",987.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",869,88,,695.20,,,0,"percent of total billed charges","88% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",435.49,987.5,
"METHOTREXATE 125MG/5ML INJ",2720002892,CDM,250,RC,,,Outpatient,,,987.5,493.75,,987.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",750.5,76,,600.40,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",711,72,,568.80,,,0,"percent of total billed charges","72% of total billed charges",740.63,75,,592.50,,,0,"percent of total billed charges","75% of total billed charges",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",711,72,,568.80,,,0,"percent of total billed charges","72% of total billed charges",592.5,60,,474.00,,,0,"percent of total billed charges","60% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",444.38,45,,355.50,,,0,"percent of total billed charges","45% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",987.5,100,,,,,0,"fee schedule","100% CMS fee schedule",987.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",641.88,65,,513.50,,,0,"percent of total billed charges","65% of total billed charges",435.49,27,,348.39,,,0,"percent of total billed charges","27% of total billed charges",938.13,95,,750.50,,,0,"percent of total billed charges","95% of total billed charges",987.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",869,88,,695.20,,,0,"percent of total billed charges","88% of total billed charges",888.75,90,,711.00,,,0,"percent of total billed charges","90% of total billed charges",435.49,987.5,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002895,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002896,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"COMPAZINE 25MG SUPP",2720002902,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"COMPAZINE 25MG SUPP",2720002903,CDM,250,RC,,,Outpatient,,,17.64,8.82,,17.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",13.41,76,,10.73,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",13.23,75,,10.58,,,0,"percent of total billed charges","75% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.7,72,,10.16,,,0,"percent of total billed charges","72% of total billed charges",10.58,60,,8.46,,,0,"percent of total billed charges","60% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.94,45,,6.35,,,0,"percent of total billed charges","45% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% CMS fee schedule",17.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.47,65,,9.18,,,0,"percent of total billed charges","65% of total billed charges",7.78,27,,6.22,,,0,"percent of total billed charges","27% of total billed charges",16.76,95,,13.41,,,0,"percent of total billed charges","95% of total billed charges",17.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",15.52,88,,12.42,,,0,"percent of total billed charges","88% of total billed charges",15.88,90,,12.70,,,0,"percent of total billed charges","90% of total billed charges",7.78,17.64,
"METRONIDAZOLE VAGINAL GEL 0.75",2720002906,CDM,250,RC,,,Outpatient,,,128.99,64.495,,128.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",98.03,76,,78.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",96.74,75,,77.39,,,0,"percent of total billed charges","75% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",77.39,60,,61.91,,,0,"percent of total billed charges","60% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",58.05,45,,46.44,,,0,"percent of total billed charges","45% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.84,65,,67.07,,,0,"percent of total billed charges","65% of total billed charges",56.88,27,,45.50,,,0,"percent of total billed charges","27% of total billed charges",122.54,95,,98.03,,,0,"percent of total billed charges","95% of total billed charges",128.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",113.51,88,,90.81,,,0,"percent of total billed charges","88% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",56.88,128.99,
"METRONIDAZOLE VAGINAL GEL 0.75",2720002907,CDM,250,RC,,,Outpatient,,,128.99,64.495,,128.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",98.03,76,,78.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",96.74,75,,77.39,,,0,"percent of total billed charges","75% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",77.39,60,,61.91,,,0,"percent of total billed charges","60% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",58.05,45,,46.44,,,0,"percent of total billed charges","45% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.84,65,,67.07,,,0,"percent of total billed charges","65% of total billed charges",56.88,27,,45.50,,,0,"percent of total billed charges","27% of total billed charges",122.54,95,,98.03,,,0,"percent of total billed charges","95% of total billed charges",128.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",113.51,88,,90.81,,,0,"percent of total billed charges","88% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",56.88,128.99,
"METRONIDAZOLE VAGINAL GEL0.75%",2720002910,CDM,250,RC,,,Outpatient,,,128.99,64.495,,128.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",98.03,76,,78.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",96.74,75,,77.39,,,0,"percent of total billed charges","75% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",77.39,60,,61.91,,,0,"percent of total billed charges","60% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",58.05,45,,46.44,,,0,"percent of total billed charges","45% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.84,65,,67.07,,,0,"percent of total billed charges","65% of total billed charges",56.88,27,,45.50,,,0,"percent of total billed charges","27% of total billed charges",122.54,95,,98.03,,,0,"percent of total billed charges","95% of total billed charges",128.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",113.51,88,,90.81,,,0,"percent of total billed charges","88% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",56.88,128.99,
"METRONIDAZOLE VAGINAL GEL0.75%",2720002911,CDM,250,RC,,,Outpatient,,,128.99,64.495,,128.99,125,,,,,0,"fee schedule","125% of CMS fee schedule",98.03,76,,78.42,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",96.74,75,,77.39,,,0,"percent of total billed charges","75% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.87,72,,74.30,,,0,"percent of total billed charges","72% of total billed charges",77.39,60,,61.91,,,0,"percent of total billed charges","60% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",58.05,45,,46.44,,,0,"percent of total billed charges","45% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% CMS fee schedule",128.99,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.84,65,,67.07,,,0,"percent of total billed charges","65% of total billed charges",56.88,27,,45.50,,,0,"percent of total billed charges","27% of total billed charges",122.54,95,,98.03,,,0,"percent of total billed charges","95% of total billed charges",128.99,75,,,,,0,"fee schedule","75% of CMS fee schedule",113.51,88,,90.81,,,0,"percent of total billed charges","88% of total billed charges",116.09,90,,92.87,,,0,"percent of total billed charges","90% of total billed charges",56.88,128.99,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002918,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"NEO/POLY(BACI OPHTH OINT 3.5G)",2720002919,CDM,250,RC,,,Outpatient,,,74.97,37.485,,74.97,125,,,,,0,"fee schedule","125% of CMS fee schedule",56.98,76,,45.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",56.23,75,,44.98,,,0,"percent of total billed charges","75% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",53.98,72,,43.18,,,0,"percent of total billed charges","72% of total billed charges",44.98,60,,35.98,,,0,"percent of total billed charges","60% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.74,45,,26.99,,,0,"percent of total billed charges","45% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% CMS fee schedule",74.97,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.73,65,,38.98,,,0,"percent of total billed charges","65% of total billed charges",33.06,27,,26.45,,,0,"percent of total billed charges","27% of total billed charges",71.22,95,,56.98,,,0,"percent of total billed charges","95% of total billed charges",74.97,75,,,,,0,"fee schedule","75% of CMS fee schedule",65.97,88,,52.78,,,0,"percent of total billed charges","88% of total billed charges",67.47,90,,53.98,,,0,"percent of total billed charges","90% of total billed charges",33.06,74.97,
"BSS PLUS IRRIGATION 500ML",2720002922,CDM,250,RC,,,Outpatient,,,320.75,160.375,,320.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",243.77,76,,195.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",230.94,72,,184.75,,,0,"percent of total billed charges","72% of total billed charges",240.56,75,,192.45,,,0,"percent of total billed charges","75% of total billed charges",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",230.94,72,,184.75,,,0,"percent of total billed charges","72% of total billed charges",192.45,60,,153.96,,,0,"percent of total billed charges","60% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",144.34,45,,115.47,,,0,"percent of total billed charges","45% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",320.75,100,,,,,0,"fee schedule","100% CMS fee schedule",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",208.49,65,,166.79,,,0,"percent of total billed charges","65% of total billed charges",141.45,27,,113.16,,,0,"percent of total billed charges","27% of total billed charges",304.71,95,,243.77,,,0,"percent of total billed charges","95% of total billed charges",320.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",282.26,88,,225.81,,,0,"percent of total billed charges","88% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",141.45,320.75,
"BSS PLUS IRRIGATION 500ML",2720002923,CDM,250,RC,,,Outpatient,,,320.75,160.375,,320.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",243.77,76,,195.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",230.94,72,,184.75,,,0,"percent of total billed charges","72% of total billed charges",240.56,75,,192.45,,,0,"percent of total billed charges","75% of total billed charges",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",230.94,72,,184.75,,,0,"percent of total billed charges","72% of total billed charges",192.45,60,,153.96,,,0,"percent of total billed charges","60% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",144.34,45,,115.47,,,0,"percent of total billed charges","45% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",320.75,100,,,,,0,"fee schedule","100% CMS fee schedule",320.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",208.49,65,,166.79,,,0,"percent of total billed charges","65% of total billed charges",141.45,27,,113.16,,,0,"percent of total billed charges","27% of total billed charges",304.71,95,,243.77,,,0,"percent of total billed charges","95% of total billed charges",320.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",282.26,88,,225.81,,,0,"percent of total billed charges","88% of total billed charges",288.68,90,,230.94,,,0,"percent of total billed charges","90% of total billed charges",141.45,320.75,
"MOCHOLE-E KIT 1%",2720002934,CDM,250,RC,,,Outpatient,,,390.75,195.375,,390.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",296.97,76,,237.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",281.34,72,,225.07,,,0,"percent of total billed charges","72% of total billed charges",293.06,75,,234.45,,,0,"percent of total billed charges","75% of total billed charges",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",281.34,72,,225.07,,,0,"percent of total billed charges","72% of total billed charges",234.45,60,,187.56,,,0,"percent of total billed charges","60% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",175.84,45,,140.67,,,0,"percent of total billed charges","45% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",390.75,100,,,,,0,"fee schedule","100% CMS fee schedule",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",253.99,65,,203.19,,,0,"percent of total billed charges","65% of total billed charges",172.32,27,,137.86,,,0,"percent of total billed charges","27% of total billed charges",371.21,95,,296.97,,,0,"percent of total billed charges","95% of total billed charges",390.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",343.86,88,,275.09,,,0,"percent of total billed charges","88% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",172.32,390.75,
"MOCHOLE-E KIT 1%",2720002935,CDM,250,RC,,,Outpatient,,,390.75,195.375,,390.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",296.97,76,,237.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",281.34,72,,225.07,,,0,"percent of total billed charges","72% of total billed charges",293.06,75,,234.45,,,0,"percent of total billed charges","75% of total billed charges",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",281.34,72,,225.07,,,0,"percent of total billed charges","72% of total billed charges",234.45,60,,187.56,,,0,"percent of total billed charges","60% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",175.84,45,,140.67,,,0,"percent of total billed charges","45% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",390.75,100,,,,,0,"fee schedule","100% CMS fee schedule",390.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",253.99,65,,203.19,,,0,"percent of total billed charges","65% of total billed charges",172.32,27,,137.86,,,0,"percent of total billed charges","27% of total billed charges",371.21,95,,296.97,,,0,"percent of total billed charges","95% of total billed charges",390.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",343.86,88,,275.09,,,0,"percent of total billed charges","88% of total billed charges",351.68,90,,281.34,,,0,"percent of total billed charges","90% of total billed charges",172.32,390.75,
"LITTLE REMEDIES 0.125% 15ML",2720002938,CDM,250,RC,,,Outpatient,,,15.45,7.725,,15.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.74,76,,9.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.59,75,,9.27,,,0,"percent of total billed charges","75% of total billed charges",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.27,60,,7.42,,,0,"percent of total billed charges","60% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.45,100,,,,,0,"fee schedule","100% CMS fee schedule",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.68,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.6,88,,10.88,,,0,"percent of total billed charges","88% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.45,
"LITTLE REMEDIES 0.125% 15ML",2720002939,CDM,250,RC,,,Outpatient,,,15.45,7.725,,15.45,125,,,,,0,"fee schedule","125% of CMS fee schedule",11.74,76,,9.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",11.59,75,,9.27,,,0,"percent of total billed charges","75% of total billed charges",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.12,72,,8.90,,,0,"percent of total billed charges","72% of total billed charges",9.27,60,,7.42,,,0,"percent of total billed charges","60% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",6.95,45,,5.56,,,0,"percent of total billed charges","45% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.45,100,,,,,0,"fee schedule","100% CMS fee schedule",15.45,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.04,65,,8.03,,,0,"percent of total billed charges","65% of total billed charges",6.81,27,,5.45,,,0,"percent of total billed charges","27% of total billed charges",14.68,95,,11.74,,,0,"percent of total billed charges","95% of total billed charges",15.45,75,,,,,0,"fee schedule","75% of CMS fee schedule",13.6,88,,10.88,,,0,"percent of total billed charges","88% of total billed charges",13.91,90,,11.13,,,0,"percent of total billed charges","90% of total billed charges",6.81,15.45,
"MUPIROCIN 2% 30G",2720002946,CDM,250,RC,,,Outpatient,,,1163.75,581.875,,1163.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",884.45,76,,707.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",837.9,72,,670.32,,,0,"percent of total billed charges","72% of total billed charges",872.81,75,,698.25,,,0,"percent of total billed charges","75% of total billed charges",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",837.9,72,,670.32,,,0,"percent of total billed charges","72% of total billed charges",698.25,60,,558.60,,,0,"percent of total billed charges","60% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",523.69,45,,418.95,,,0,"percent of total billed charges","45% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",1163.75,100,,,,,0,"fee schedule","100% CMS fee schedule",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",756.44,65,,605.15,,,0,"percent of total billed charges","65% of total billed charges",513.21,27,,410.57,,,0,"percent of total billed charges","27% of total billed charges",1105.56,95,,884.45,,,0,"percent of total billed charges","95% of total billed charges",1163.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",1024.1,88,,819.28,,,0,"percent of total billed charges","88% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",513.21,1163.75,
"MUPIROCIN 2% 30G",2720002947,CDM,250,RC,,,Outpatient,,,1163.75,581.875,,1163.75,125,,,,,0,"fee schedule","125% of CMS fee schedule",884.45,76,,707.56,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",837.9,72,,670.32,,,0,"percent of total billed charges","72% of total billed charges",872.81,75,,698.25,,,0,"percent of total billed charges","75% of total billed charges",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",837.9,72,,670.32,,,0,"percent of total billed charges","72% of total billed charges",698.25,60,,558.60,,,0,"percent of total billed charges","60% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",523.69,45,,418.95,,,0,"percent of total billed charges","45% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",1163.75,100,,,,,0,"fee schedule","100% CMS fee schedule",1163.75,100,,,,,0,"fee schedule","100% of CMS fee schedule",756.44,65,,605.15,,,0,"percent of total billed charges","65% of total billed charges",513.21,27,,410.57,,,0,"percent of total billed charges","27% of total billed charges",1105.56,95,,884.45,,,0,"percent of total billed charges","95% of total billed charges",1163.75,75,,,,,0,"fee schedule","75% of CMS fee schedule",1024.1,88,,819.28,,,0,"percent of total billed charges","88% of total billed charges",1047.38,90,,837.90,,,0,"percent of total billed charges","90% of total billed charges",513.21,1163.75,
"SOD THIOSULFATE 25% INJ",2720002974,CDM,250,RC,,,Outpatient,,,103.64,51.82,,103.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",78.77,76,,63.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",77.73,75,,62.18,,,0,"percent of total billed charges","75% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",62.18,60,,49.74,,,0,"percent of total billed charges","60% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",46.64,45,,37.31,,,0,"percent of total billed charges","45% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.37,65,,53.90,,,0,"percent of total billed charges","65% of total billed charges",45.71,27,,36.57,,,0,"percent of total billed charges","27% of total billed charges",98.46,95,,78.77,,,0,"percent of total billed charges","95% of total billed charges",103.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",91.2,88,,72.96,,,0,"percent of total billed charges","88% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",45.71,103.64,
"SOD THIOSULFATE 25% INJ",2720002975,CDM,250,RC,,,Outpatient,,,103.64,51.82,,103.64,125,,,,,0,"fee schedule","125% of CMS fee schedule",78.77,76,,63.02,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",77.73,75,,62.18,,,0,"percent of total billed charges","75% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",74.62,72,,59.70,,,0,"percent of total billed charges","72% of total billed charges",62.18,60,,49.74,,,0,"percent of total billed charges","60% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",46.64,45,,37.31,,,0,"percent of total billed charges","45% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% CMS fee schedule",103.64,100,,,,,0,"fee schedule","100% of CMS fee schedule",67.37,65,,53.90,,,0,"percent of total billed charges","65% of total billed charges",45.71,27,,36.57,,,0,"percent of total billed charges","27% of total billed charges",98.46,95,,78.77,,,0,"percent of total billed charges","95% of total billed charges",103.64,75,,,,,0,"fee schedule","75% of CMS fee schedule",91.2,88,,72.96,,,0,"percent of total billed charges","88% of total billed charges",93.28,90,,74.62,,,0,"percent of total billed charges","90% of total billed charges",45.71,103.64,
"NEVIRAPINE 50MG/5ML SUSP",2720002978,CDM,250,RC,,,Outpatient,,,13.5,6.75,,13.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.26,76,,8.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.72,72,,7.78,,,0,"percent of total billed charges","72% of total billed charges",10.13,75,,8.10,,,0,"percent of total billed charges","75% of total billed charges",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,72,,7.78,,,0,"percent of total billed charges","72% of total billed charges",8.1,60,,6.48,,,0,"percent of total billed charges","60% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",6.08,45,,4.86,,,0,"percent of total billed charges","45% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.5,100,,,,,0,"fee schedule","100% CMS fee schedule",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.78,65,,7.02,,,0,"percent of total billed charges","65% of total billed charges",5.95,27,,4.76,,,0,"percent of total billed charges","27% of total billed charges",12.83,95,,10.26,,,0,"percent of total billed charges","95% of total billed charges",13.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.88,88,,9.50,,,0,"percent of total billed charges","88% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",5.95,13.5,
"NEVIRAPINE 50MG/5ML SUSP",2720002979,CDM,250,RC,,,Outpatient,,,13.5,6.75,,13.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",10.26,76,,8.21,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",9.72,72,,7.78,,,0,"percent of total billed charges","72% of total billed charges",10.13,75,,8.10,,,0,"percent of total billed charges","75% of total billed charges",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",9.72,72,,7.78,,,0,"percent of total billed charges","72% of total billed charges",8.1,60,,6.48,,,0,"percent of total billed charges","60% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",6.08,45,,4.86,,,0,"percent of total billed charges","45% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",13.5,100,,,,,0,"fee schedule","100% CMS fee schedule",13.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.78,65,,7.02,,,0,"percent of total billed charges","65% of total billed charges",5.95,27,,4.76,,,0,"percent of total billed charges","27% of total billed charges",12.83,95,,10.26,,,0,"percent of total billed charges","95% of total billed charges",13.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",11.88,88,,9.50,,,0,"percent of total billed charges","88% of total billed charges",12.15,90,,9.72,,,0,"percent of total billed charges","90% of total billed charges",5.95,13.5,
"LANOLIN CREAM 40GM",2720002982,CDM,250,RC,,,Outpatient,,,34.2,17.1,,34.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",25.99,76,,20.79,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",24.62,72,,19.70,,,0,"percent of total billed charges","72% of total billed charges",25.65,75,,20.52,,,0,"percent of total billed charges","75% of total billed charges",34.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",24.62,72,,19.70,,,0,"percent of total billed charges","72% of total billed charges",20.52,60,,16.42,,,0,"percent of total billed charges","60% of total billed charges",30.78,90,,24.62,,,0,"percent of total billed charges","90% of total billed charges",15.39,45,,12.31,,,0,"percent of total billed charges","45% of total billed charges",30.78,90,,24.62,,,0,"percent of total billed charges","90% of total billed charges",34.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",34.2,100,,,,,0,"fee schedule","100% CMS fee schedule",34.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.23,65,,17.78,,,0,"percent of total billed charges","65% of total billed charges",15.08,27,,12.06,,,0,"percent of total billed charges","27% of total billed charges",32.49,95,,25.99,,,0,"percent of total billed charges","95% of total billed charges",34.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",30.1,88,,24.08,,,0,"percent of total billed charges","88% of total billed charges",30.78,90,,24.62,,,0,"percent of total billed charges","90% of total billed charges",15.08,34.2,
"ASCOR 250000 MG/50 ML INJ",2720002984,CDM,250,RC,,,Outpatient,,,844.27,422.135,,844.27,125,,,,,0,"fee schedule","125% of CMS fee schedule",641.65,76,,513.32,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",607.87,72,,486.30,,,0,"percent of total billed charges","72% of total billed charges",633.2,75,,506.56,,,0,"percent of total billed charges","75% of total billed charges",844.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",607.87,72,,486.30,,,0,"percent of total billed charges","72% of total billed charges",506.56,60,,405.25,,,0,"percent of total billed charges","60% of total billed charges",759.84,90,,607.87,,,0,"percent of total billed charges","90% of total billed charges",379.92,45,,303.94,,,0,"percent of total billed charges","45% of total billed charges",759.84,90,,607.87,,,0,"percent of total billed charges","90% of total billed charges",844.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",844.27,100,,,,,0,"fee schedule","100% CMS fee schedule",844.27,100,,,,,0,"fee schedule","100% of CMS fee schedule",548.78,65,,439.02,,,0,"percent of total billed charges","65% of total billed charges",372.32,27,,297.86,,,0,"percent of total billed charges","27% of total billed charges",802.06,95,,641.65,,,0,"percent of total billed charges","95% of total billed charges",844.27,75,,,,,0,"fee schedule","75% of CMS fee schedule",742.96,88,,594.37,,,0,"percent of total billed charges","88% of total billed charges",759.84,90,,607.87,,,0,"percent of total billed charges","90% of total billed charges",372.32,844.27,
"MELATONIN 5MG TAB",2720002986,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"MELATONIN 3MG TAB",2720002988,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"REMDESIVIR 100MG INJ",2720002990,CDM,250,RC,J0248,HCPCS,Outpatient,,,2054,1027,TB,7.93,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1561.04,76,,1248.83,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1478.88,72,,1183.10,,,0,"percent of total billed charges","72% of total billed charges",1540.5,75,,1232.40,,,0,"percent of total billed charges","75% of total billed charges",6.35,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1478.88,72,,1183.10,,,0,"percent of total billed charges","72% of total billed charges",1232.4,60,,985.92,,,0,"percent of total billed charges","60% of total billed charges",1848.6,90,,1478.88,,,0,"percent of total billed charges","90% of total billed charges",924.3,45,,739.44,,,0,"percent of total billed charges","45% of total billed charges",1848.6,90,,1478.88,,,0,"percent of total billed charges","90% of total billed charges",6.35,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.35,100,,,,,0,"fee schedule","100% of CMS OPPS rate",6.35,100,,,,,0,"fee schedule","100% of CMS OPPS rate",12.7,100,,,,,0,"fee schedule","100% of CMS OPPS rate",905.81,27,,724.65,,,0,"percent of total billed charges","27% of total billed charges",1951.3,95,,1561.04,,,0,"percent of total billed charges","95% of total billed charges",4.76,100,,,,,0,"fee schedule","100% of CMS OPPS rate",1807.52,88,,1446.02,,,0,"percent of total billed charges","88% of total billed charges",1848.6,90,,1478.88,,,0,"percent of total billed charges","90% of total billed charges",4.76,1951.3,
"STRESS WITH IRON TAB",2720002992,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"DIFICID 200MG TAB",2720002994,CDM,250,RC,,,Outpatient,,,669.77,334.885,,669.77,125,,,,,0,"fee schedule","125% of CMS fee schedule",509.03,76,,407.22,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",482.23,72,,385.78,,,0,"percent of total billed charges","72% of total billed charges",502.33,75,,401.86,,,0,"percent of total billed charges","75% of total billed charges",669.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",482.23,72,,385.78,,,0,"percent of total billed charges","72% of total billed charges",401.86,60,,321.49,,,0,"percent of total billed charges","60% of total billed charges",602.79,90,,482.23,,,0,"percent of total billed charges","90% of total billed charges",301.4,45,,241.12,,,0,"percent of total billed charges","45% of total billed charges",602.79,90,,482.23,,,0,"percent of total billed charges","90% of total billed charges",669.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",669.77,100,,,,,0,"fee schedule","100% CMS fee schedule",669.77,100,,,,,0,"fee schedule","100% of CMS fee schedule",435.35,65,,348.28,,,0,"percent of total billed charges","65% of total billed charges",295.37,27,,236.30,,,0,"percent of total billed charges","27% of total billed charges",636.28,95,,509.02,,,0,"percent of total billed charges","95% of total billed charges",669.77,75,,,,,0,"fee schedule","75% of CMS fee schedule",589.4,88,,471.52,,,0,"percent of total billed charges","88% of total billed charges",602.79,90,,482.23,,,0,"percent of total billed charges","90% of total billed charges",295.37,669.77,
"HEPARIN/0.45% NS 25,000U/250ML",2720002996,CDM,250,RC,,,Outpatient,,,47,23.5,,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",35.25,75,,28.20,,,0,"percent of total billed charges","75% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",33.84,72,,27.07,,,0,"percent of total billed charges","72% of total billed charges",28.2,60,,22.56,,,0,"percent of total billed charges","60% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,16.58,,,0,"percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",20.73,47,
"HEPARIN/0.45% NS 25,000U/250ML",2720002997,CDM,250,RC,J1644,HCPCS,Outpatient,,,47,23.5,U8,47,125,,,,,0,"fee schedule","125% of CMS fee schedule",35.72,76,,28.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",0.67,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",0.67,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",0.19,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",21.15,45,,16.92,,,0,"percent of total billed charges","45% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",47,100,,,,,0,"fee schedule","100% CMS fee schedule",47,100,,,,,0,"fee schedule","100% of CMS fee schedule",30.55,65,,24.44,,,0,"percent of total billed charges","65% of total billed charges",20.73,27,,47.59,21.49,682.31,"1 through 10","percent of total billed charges","27% of total billed charges",44.65,95,,35.72,,,0,"percent of total billed charges","95% of total billed charges",47,75,,,,,0,"fee schedule","75% of CMS fee schedule",41.36,88,,33.09,,,0,"percent of total billed charges","88% of total billed charges",42.3,90,,33.84,,,0,"percent of total billed charges","90% of total billed charges",0.19,47,
"ZENPEP 10000 UNITS CAP",2720003000,CDM,250,RC,,,Outpatient,,,12.32,6.16,,12.32,125,,,,,0,"fee schedule","125% of CMS fee schedule",9.36,76,,7.49,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",8.87,72,,7.10,,,0,"percent of total billed charges","72% of total billed charges",9.24,75,,7.39,,,0,"percent of total billed charges","75% of total billed charges",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.87,72,,7.10,,,0,"percent of total billed charges","72% of total billed charges",7.39,60,,5.91,,,0,"percent of total billed charges","60% of total billed charges",11.09,90,,8.87,,,0,"percent of total billed charges","90% of total billed charges",5.54,45,,4.43,,,0,"percent of total billed charges","45% of total billed charges",11.09,90,,8.87,,,0,"percent of total billed charges","90% of total billed charges",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",12.32,100,,,,,0,"fee schedule","100% CMS fee schedule",12.32,100,,,,,0,"fee schedule","100% of CMS fee schedule",8.01,65,,6.41,,,0,"percent of total billed charges","65% of total billed charges",5.43,27,,4.34,,,0,"percent of total billed charges","27% of total billed charges",11.7,95,,9.36,,,0,"percent of total billed charges","95% of total billed charges",12.32,75,,,,,0,"fee schedule","75% of CMS fee schedule",10.84,88,,8.67,,,0,"percent of total billed charges","88% of total billed charges",11.09,90,,8.87,,,0,"percent of total billed charges","90% of total billed charges",5.43,12.32,
"FONDAPRINUX 2.5MG/0.5ML INJ",2720003002,CDM,250,RC,J1652,HCPCS,Outpatient,,,142.2,71.1,U8,142.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",108.07,76,,86.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",63.99,45,,51.19,,,0,"percent of total billed charges","45% of total billed charges",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.2,100,,,,,0,"fee schedule","100% CMS fee schedule",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.43,65,,73.94,,,0,"percent of total billed charges","65% of total billed charges",62.71,27,,50.17,,,0,"percent of total billed charges","27% of total billed charges",135.09,95,,108.07,,,0,"percent of total billed charges","95% of total billed charges",142.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",125.14,88,,100.11,,,0,"percent of total billed charges","88% of total billed charges",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",2.07,142.2,
"FONDAPRINUX 2.5MG/0.5ML INJ",2720003003,CDM,250,RC,J1652,HCPCS,Outpatient,,,142.2,71.1,U8,142.2,125,,,,,0,"fee schedule","125% of CMS fee schedule",108.07,76,,86.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",63.99,45,,51.19,,,0,"percent of total billed charges","45% of total billed charges",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.2,100,,,,,0,"fee schedule","100% CMS fee schedule",142.2,100,,,,,0,"fee schedule","100% of CMS fee schedule",92.43,65,,73.94,,,0,"percent of total billed charges","65% of total billed charges",62.71,27,,50.17,,,0,"percent of total billed charges","27% of total billed charges",135.09,95,,108.07,,,0,"percent of total billed charges","95% of total billed charges",142.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",125.14,88,,100.11,,,0,"percent of total billed charges","88% of total billed charges",127.98,90,,102.38,,,0,"percent of total billed charges","90% of total billed charges",2.07,142.2,
"FONDAPRINUX 10MG/0.8MG INJ",2720003006,CDM,250,RC,J1652,HCPCS,Outpatient,,,536.41,268.205,U8,536.41,125,,,,,0,"fee schedule","125% of CMS fee schedule",407.67,76,,326.14,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",7.25,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS fee schedule",536.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",7.25,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",2.07,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",482.77,90,,386.22,,,0,"percent of total billed charges","90% of total billed charges",241.38,45,,193.10,,,0,"percent of total billed charges","45% of total billed charges",482.77,90,,386.22,,,0,"percent of total billed charges","90% of total billed charges",536.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",536.41,100,,,,,0,"fee schedule","100% CMS fee schedule",536.41,100,,,,,0,"fee schedule","100% of CMS fee schedule",348.67,65,,278.94,,,0,"percent of total billed charges","65% of total billed charges",236.56,27,,189.25,,,0,"percent of total billed charges","27% of total billed charges",509.59,95,,407.67,,,0,"percent of total billed charges","95% of total billed charges",536.41,75,,,,,0,"fee schedule","75% of CMS fee schedule",472.04,88,,377.63,,,0,"percent of total billed charges","88% of total billed charges",482.77,90,,386.22,,,0,"percent of total billed charges","90% of total billed charges",2.07,536.41,
"HYDROCORTISONE 1% PACKETS",2720003010,CDM,250,RC,,,Outpatient,,,6.5,3.25,,6.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",4.94,76,,3.95,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",4.88,75,,3.90,,,0,"percent of total billed charges","75% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.68,72,,3.74,,,0,"percent of total billed charges","72% of total billed charges",3.9,60,,3.12,,,0,"percent of total billed charges","60% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.93,45,,2.34,,,0,"percent of total billed charges","45% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% CMS fee schedule",6.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",4.23,65,,3.38,,,0,"percent of total billed charges","65% of total billed charges",2.87,27,,2.30,,,0,"percent of total billed charges","27% of total billed charges",6.18,95,,4.94,,,0,"percent of total billed charges","95% of total billed charges",6.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",5.72,88,,4.58,,,0,"percent of total billed charges","88% of total billed charges",5.85,90,,4.68,,,0,"percent of total billed charges","90% of total billed charges",2.87,6.5,
"Misoprostol  25 mcg",2720003022,CDM,250,RC,,,Outpatient,,,22.05,11.025,,22.05,125,,,,,0,"fee schedule","125% of CMS fee schedule",16.76,76,,13.41,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",16.54,75,,13.23,,,0,"percent of total billed charges","75% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",15.88,72,,12.70,,,0,"percent of total billed charges","72% of total billed charges",13.23,60,,10.58,,,0,"percent of total billed charges","60% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.92,45,,7.94,,,0,"percent of total billed charges","45% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% CMS fee schedule",22.05,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.33,65,,11.46,,,0,"percent of total billed charges","65% of total billed charges",9.72,27,,7.78,,,0,"percent of total billed charges","27% of total billed charges",20.95,95,,16.76,,,0,"percent of total billed charges","95% of total billed charges",22.05,75,,,,,0,"fee schedule","75% of CMS fee schedule",19.4,88,,15.52,,,0,"percent of total billed charges","88% of total billed charges",19.85,90,,15.88,,,0,"percent of total billed charges","90% of total billed charges",9.72,22.05,
"Cyanokit 5gm",2720003024,CDM,250,RC,,,Outpatient,,,8246.9,4123.45,,8246.9,125,,,,,0,"fee schedule","125% of CMS fee schedule",6267.64,76,,5014.11,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",5937.77,72,,4750.22,,,0,"percent of total billed charges","72% of total billed charges",6185.18,75,,4948.14,,,0,"percent of total billed charges","75% of total billed charges",8246.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",5937.77,72,,4750.22,,,0,"percent of total billed charges","72% of total billed charges",4948.14,60,,3958.51,,,0,"percent of total billed charges","60% of total billed charges",7422.21,90,,5937.77,,,0,"percent of total billed charges","90% of total billed charges",3711.11,45,,2968.89,,,0,"percent of total billed charges","45% of total billed charges",7422.21,90,,5937.77,,,0,"percent of total billed charges","90% of total billed charges",8246.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",8246.9,100,,,,,0,"fee schedule","100% CMS fee schedule",8246.9,100,,,,,0,"fee schedule","100% of CMS fee schedule",5360.49,65,,4288.39,,,0,"percent of total billed charges","65% of total billed charges",3636.88,27,,2909.50,,,0,"percent of total billed charges","27% of total billed charges",7834.56,95,,6267.65,,,0,"percent of total billed charges","95% of total billed charges",8246.9,75,,,,,0,"fee schedule","75% of CMS fee schedule",7257.27,88,,5805.82,,,0,"percent of total billed charges","88% of total billed charges",7422.21,90,,5937.77,,,0,"percent of total billed charges","90% of total billed charges",3636.88,8246.9,
"Dermoplast First Aid Spray",2720003026,CDM,250,RC,,,Outpatient,,,120.5,60.25,,120.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",91.58,76,,73.26,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",86.76,72,,69.41,,,0,"percent of total billed charges","72% of total billed charges",90.38,75,,72.30,,,0,"percent of total billed charges","75% of total billed charges",120.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",86.76,72,,69.41,,,0,"percent of total billed charges","72% of total billed charges",72.3,60,,57.84,,,0,"percent of total billed charges","60% of total billed charges",108.45,90,,86.76,,,0,"percent of total billed charges","90% of total billed charges",54.23,45,,43.38,,,0,"percent of total billed charges","45% of total billed charges",108.45,90,,86.76,,,0,"percent of total billed charges","90% of total billed charges",120.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",120.5,100,,,,,0,"fee schedule","100% CMS fee schedule",120.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",78.33,65,,62.66,,,0,"percent of total billed charges","65% of total billed charges",53.14,27,,42.51,,,0,"percent of total billed charges","27% of total billed charges",114.48,95,,91.58,,,0,"percent of total billed charges","95% of total billed charges",120.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",106.04,88,,84.83,,,0,"percent of total billed charges","88% of total billed charges",108.45,90,,86.76,,,0,"percent of total billed charges","90% of total billed charges",53.14,120.5,
"Solarcaine Spray 127gm",2720003028,CDM,250,RC,,,Outpatient,,,57.5,28.75,,57.5,125,,,,,0,"fee schedule","125% of CMS fee schedule",43.7,76,,34.96,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",41.4,72,,33.12,,,0,"percent of total billed charges","72% of total billed charges",43.13,75,,34.50,,,0,"percent of total billed charges","75% of total billed charges",57.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",41.4,72,,33.12,,,0,"percent of total billed charges","72% of total billed charges",34.5,60,,27.60,,,0,"percent of total billed charges","60% of total billed charges",51.75,90,,41.40,,,0,"percent of total billed charges","90% of total billed charges",25.88,45,,20.70,,,0,"percent of total billed charges","45% of total billed charges",51.75,90,,41.40,,,0,"percent of total billed charges","90% of total billed charges",57.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",57.5,100,,,,,0,"fee schedule","100% CMS fee schedule",57.5,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.38,65,,29.90,,,0,"percent of total billed charges","65% of total billed charges",25.36,27,,20.29,,,0,"percent of total billed charges","27% of total billed charges",54.63,95,,43.70,,,0,"percent of total billed charges","95% of total billed charges",57.5,75,,,,,0,"fee schedule","75% of CMS fee schedule",50.6,88,,40.48,,,0,"percent of total billed charges","88% of total billed charges",51.75,90,,41.40,,,0,"percent of total billed charges","90% of total billed charges",25.36,57.5,
"Duraclon 1000mcg/10ml vial",2720003030,CDM,250,RC,J0735,HCPCS,Outpatient,,,521.4,260.7,,521.4,125,,,,,0,"fee schedule","125% of CMS fee schedule",396.26,76,,317.01,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",48.72,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",48.72,350,,,,,0,"fee schedule","350% of BCBS fee schedule",521.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",48.72,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",13.92,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",469.26,90,,375.41,,,0,"percent of total billed charges","90% of total billed charges",234.63,45,,187.70,,,0,"percent of total billed charges","45% of total billed charges",469.26,90,,375.41,,,0,"percent of total billed charges","90% of total billed charges",521.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",521.4,100,,,,,0,"fee schedule","100% CMS fee schedule",521.4,100,,,,,0,"fee schedule","100% of CMS fee schedule",338.91,65,,271.13,,,0,"percent of total billed charges","65% of total billed charges",229.94,27,,183.95,,,0,"percent of total billed charges","27% of total billed charges",495.33,95,,396.26,,,0,"percent of total billed charges","95% of total billed charges",521.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",458.83,88,,367.06,,,0,"percent of total billed charges","88% of total billed charges",469.26,90,,375.41,,,0,"percent of total billed charges","90% of total billed charges",13.92,521.4,
"Fosfomycin 3gm Powder",2720003034,CDM,250,RC,,,Outpatient,,,200.78,100.39,,200.78,125,,,,,0,"fee schedule","125% of CMS fee schedule",152.59,76,,122.07,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",144.56,72,,115.65,,,0,"percent of total billed charges","72% of total billed charges",150.59,75,,120.47,,,0,"percent of total billed charges","75% of total billed charges",200.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",144.56,72,,115.65,,,0,"percent of total billed charges","72% of total billed charges",120.47,60,,96.38,,,0,"percent of total billed charges","60% of total billed charges",180.7,90,,144.56,,,0,"percent of total billed charges","90% of total billed charges",90.35,45,,72.28,,,0,"percent of total billed charges","45% of total billed charges",180.7,90,,144.56,,,0,"percent of total billed charges","90% of total billed charges",200.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",200.78,100,,,,,0,"fee schedule","100% CMS fee schedule",200.78,100,,,,,0,"fee schedule","100% of CMS fee schedule",130.51,65,,104.41,,,0,"percent of total billed charges","65% of total billed charges",88.54,27,,70.83,,,0,"percent of total billed charges","27% of total billed charges",190.74,95,,152.59,,,0,"percent of total billed charges","95% of total billed charges",200.78,75,,,,,0,"fee schedule","75% of CMS fee schedule",176.69,88,,141.35,,,0,"percent of total billed charges","88% of total billed charges",180.7,90,,144.56,,,0,"percent of total billed charges","90% of total billed charges",88.54,200.78,
"Fluvoxamine 100mg tab",2720003038,CDM,250,RC,,,Outpatient,,,23.03,11.515,,23.03,125,,,,,0,"fee schedule","125% of CMS fee schedule",17.5,76,,14.00,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",16.58,72,,13.26,,,0,"percent of total billed charges","72% of total billed charges",17.27,75,,13.82,,,0,"percent of total billed charges","75% of total billed charges",23.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.58,72,,13.26,,,0,"percent of total billed charges","72% of total billed charges",13.82,60,,11.06,,,0,"percent of total billed charges","60% of total billed charges",20.73,90,,16.58,,,0,"percent of total billed charges","90% of total billed charges",10.36,45,,8.29,,,0,"percent of total billed charges","45% of total billed charges",20.73,90,,16.58,,,0,"percent of total billed charges","90% of total billed charges",23.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.03,100,,,,,0,"fee schedule","100% CMS fee schedule",23.03,100,,,,,0,"fee schedule","100% of CMS fee schedule",14.97,65,,11.98,,,0,"percent of total billed charges","65% of total billed charges",10.16,27,,8.13,,,0,"percent of total billed charges","27% of total billed charges",21.88,95,,17.50,,,0,"percent of total billed charges","95% of total billed charges",23.03,75,,,,,0,"fee schedule","75% of CMS fee schedule",20.27,88,,16.22,,,0,"percent of total billed charges","88% of total billed charges",20.73,90,,16.58,,,0,"percent of total billed charges","90% of total billed charges",10.16,23.03,
"Baricitinib 2mg tab",2720003040,CDM,250,RC,,,Outpatient,,,198.15,99.075,,198.15,125,,,,,0,"fee schedule","125% of CMS fee schedule",150.59,76,,120.47,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",142.67,72,,114.14,,,0,"percent of total billed charges","72% of total billed charges",148.61,75,,118.89,,,0,"percent of total billed charges","75% of total billed charges",198.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",142.67,72,,114.14,,,0,"percent of total billed charges","72% of total billed charges",118.89,60,,95.11,,,0,"percent of total billed charges","60% of total billed charges",178.34,90,,142.67,,,0,"percent of total billed charges","90% of total billed charges",89.17,45,,71.34,,,0,"percent of total billed charges","45% of total billed charges",178.34,90,,142.67,,,0,"percent of total billed charges","90% of total billed charges",198.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",198.15,100,,,,,0,"fee schedule","100% CMS fee schedule",198.15,100,,,,,0,"fee schedule","100% of CMS fee schedule",128.8,65,,103.04,,,0,"percent of total billed charges","65% of total billed charges",87.38,27,,69.90,,,0,"percent of total billed charges","27% of total billed charges",188.24,95,,150.59,,,0,"percent of total billed charges","95% of total billed charges",198.15,75,,,,,0,"fee schedule","75% of CMS fee schedule",174.37,88,,139.50,,,0,"percent of total billed charges","88% of total billed charges",178.34,90,,142.67,,,0,"percent of total billed charges","90% of total billed charges",87.38,198.15,
"Refresh Plus 0.5% 0.4ml Ophth",2720003042,CDM,250,RC,,,Outpatient,,,16.25,8.125,,16.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.35,76,,9.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",12.19,75,,9.75,,,0,"percent of total billed charges","75% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",9.75,60,,7.80,,,0,"percent of total billed charges","60% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.31,45,,5.85,,,0,"percent of total billed charges","45% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,65,,8.45,,,0,"percent of total billed charges","65% of total billed charges",7.17,27,,5.74,,,0,"percent of total billed charges","27% of total billed charges",15.44,95,,12.35,,,0,"percent of total billed charges","95% of total billed charges",16.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.3,88,,11.44,,,0,"percent of total billed charges","88% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.17,16.25,
"Norepinephrine IN D5W 8mg/250m",2720003044,CDM,250,RC,,,Outpatient,,,332,166,,332,125,,,,,0,"fee schedule","125% of CMS fee schedule",252.32,76,,201.86,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",239.04,72,,191.23,,,0,"percent of total billed charges","72% of total billed charges",249,75,,199.20,,,0,"percent of total billed charges","75% of total billed charges",332,100,,,,,0,"fee schedule","100% of CMS fee schedule",239.04,72,,191.23,,,0,"percent of total billed charges","72% of total billed charges",199.2,60,,159.36,,,0,"percent of total billed charges","60% of total billed charges",298.8,90,,239.04,,,0,"percent of total billed charges","90% of total billed charges",149.4,45,,119.52,,,0,"percent of total billed charges","45% of total billed charges",298.8,90,,239.04,,,0,"percent of total billed charges","90% of total billed charges",332,100,,,,,0,"fee schedule","100% of CMS fee schedule",332,100,,,,,0,"fee schedule","100% CMS fee schedule",332,100,,,,,0,"fee schedule","100% of CMS fee schedule",215.8,65,,172.64,,,0,"percent of total billed charges","65% of total billed charges",146.41,27,,117.13,,,0,"percent of total billed charges","27% of total billed charges",315.4,95,,252.32,,,0,"percent of total billed charges","95% of total billed charges",332,75,,,,,0,"fee schedule","75% of CMS fee schedule",292.16,88,,233.73,,,0,"percent of total billed charges","88% of total billed charges",298.8,90,,239.04,,,0,"percent of total billed charges","90% of total billed charges",146.41,332,
Simeth,2720003046,CDM,250,RC,,,Outpatient,,,16.25,8.125,,16.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.35,76,,9.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",12.19,75,,9.75,,,0,"percent of total billed charges","75% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",9.75,60,,7.80,,,0,"percent of total billed charges","60% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.31,45,,5.85,,,0,"percent of total billed charges","45% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,65,,8.45,,,0,"percent of total billed charges","65% of total billed charges",7.17,27,,5.74,,,0,"percent of total billed charges","27% of total billed charges",15.44,95,,12.35,,,0,"percent of total billed charges","95% of total billed charges",16.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.3,88,,11.44,,,0,"percent of total billed charges","88% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.17,16.25,
SIMETH,2720003047,CDM,250,RC,,,Outpatient,,,16.25,8.125,,16.25,125,,,,,0,"fee schedule","125% of CMS fee schedule",12.35,76,,9.88,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",12.19,75,,9.75,,,0,"percent of total billed charges","75% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",11.7,72,,9.36,,,0,"percent of total billed charges","72% of total billed charges",9.75,60,,7.80,,,0,"percent of total billed charges","60% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.31,45,,5.85,,,0,"percent of total billed charges","45% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% CMS fee schedule",16.25,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.56,65,,8.45,,,0,"percent of total billed charges","65% of total billed charges",7.17,27,,5.74,,,0,"percent of total billed charges","27% of total billed charges",15.44,95,,12.35,,,0,"percent of total billed charges","95% of total billed charges",16.25,75,,,,,0,"fee schedule","75% of CMS fee schedule",14.3,88,,11.44,,,0,"percent of total billed charges","88% of total billed charges",14.63,90,,11.70,,,0,"percent of total billed charges","90% of total billed charges",7.17,16.25,
"Norepinephrine 8mg/250ml bag",2720003049,CDM,250,RC,,,Outpatient,,,348,174,,348,125,,,,,0,"fee schedule","125% of CMS fee schedule",264.48,76,,211.58,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",250.56,72,,200.45,,,0,"percent of total billed charges","72% of total billed charges",261,75,,208.80,,,0,"percent of total billed charges","75% of total billed charges",348,100,,,,,0,"fee schedule","100% of CMS fee schedule",250.56,72,,200.45,,,0,"percent of total billed charges","72% of total billed charges",208.8,60,,167.04,,,0,"percent of total billed charges","60% of total billed charges",313.2,90,,250.56,,,0,"percent of total billed charges","90% of total billed charges",156.6,45,,125.28,,,0,"percent of total billed charges","45% of total billed charges",313.2,90,,250.56,,,0,"percent of total billed charges","90% of total billed charges",348,100,,,,,0,"fee schedule","100% of CMS fee schedule",348,100,,,,,0,"fee schedule","100% CMS fee schedule",348,100,,,,,0,"fee schedule","100% of CMS fee schedule",226.2,65,,180.96,,,0,"percent of total billed charges","65% of total billed charges",153.47,27,,122.78,,,0,"percent of total billed charges","27% of total billed charges",330.6,95,,264.48,,,0,"percent of total billed charges","95% of total billed charges",348,75,,,,,0,"fee schedule","75% of CMS fee schedule",306.24,88,,244.99,,,0,"percent of total billed charges","88% of total billed charges",313.2,90,,250.56,,,0,"percent of total billed charges","90% of total billed charges",153.47,348,
"Suprapubic Cath Ins/Asp Bladde",P761000310,CDM,761,RC,51102,HCPCS,Outpatient,,,4303.88,2151.94,,4303.88,125,,,,,0,"fee schedule","125% of CMS fee schedule",3270.95,76,,2616.76,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",3098.79,72,,2479.03,,,0,"percent of total billed charges","72% of total billed charges",3227.91,75,,2582.33,,,0,"percent of total billed charges","75% of total billed charges",4303.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",3098.79,72,,2479.03,,,0,"percent of total billed charges","72% of total billed charges",2582.33,60,,2065.86,,,0,"percent of total billed charges","60% of total billed charges",3873.49,90,,3098.79,,,0,"percent of total billed charges","90% of total billed charges",1936.75,45,,1549.40,,,0,"percent of total billed charges","45% of total billed charges",3873.49,90,,3098.79,,,0,"percent of total billed charges","90% of total billed charges",4303.88,100,,,,,0,"fee schedule","100% of CMS fee schedule",4303.88,100,,,,,0,"fee schedule","100% CMS fee schedule",4303.88,100,,1615.10,1615.10,1615.10,"1 through 10","fee schedule","100% of CMS fee schedule",2797.52,65,,2238.02,,,0,"percent of total billed charges","65% of total billed charges",1898.01,27,,1518.41,,,0,"percent of total billed charges","27% of total billed charges",4088.69,95,,3270.95,,,0,"percent of total billed charges","95% of total billed charges",4303.88,75,,,,,0,"fee schedule","75% of CMS fee schedule",3787.41,88,,3029.93,,,0,"percent of total billed charges","88% of total billed charges",3873.49,90,,3098.79,,,0,"percent of total billed charges","90% of total billed charges",1898.01,4303.88,
"FNA BX W/US GDN 1ST LES",P960000001,CDM,960,RC,10005,HCPCS,Outpatient,,,272,136,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",116.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,554.73,554.73,707.56,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,110.95,110.95,110.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,424.54,198.12,650.96,"1 through 10",other,"not separately reimbursment",,,,759.25,510.58,1007.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",116.6,116.6,
"FNA BX W/O IMG GDN 1ST LES",P960000002,CDM,960,RC,10021,HCPCS,Outpatient,,,382,191,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",88.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,113.35,113.35,113.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.55,88.55,
"I&D ABSCESS",P960000003,CDM,960,RC,10030,HCPCS,Outpatient,,,2219,1109.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",552.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",552.61,552.61,
"DRAIN OF SKIN ABSCESS SIMPLE",P960000004,CDM,960,RC,10060,HCPCS,Outpatient,,,464,232,,,,,,,,0,other,"not separately reimbursement",,,,335.73,335.73,335.73,"1 through 10",other,"not separately reimbursement",108.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,130.41,112.00,174.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,93.69,93.69,93.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,156.66,76.58,156.66,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.28,67.01,96.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.96,108.96,
"DRAIN OF SKIN ABSCESS COMPLICA",P960000005,CDM,960,RC,10061,HCPCS,Outpatient,,,809,404.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",188.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,100.96,100.96,100.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,244.61,113.17,345.54,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,156.05,146.05,356.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,401.79,401.79,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.88,188.88,
"DRAINAGE OF PILONIDAL CYST",P960000006,CDM,960,RC,10080,HCPCS,Outpatient,,,715,357.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",188.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,707.56,707.56,707.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,174.14,174.14,174.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.45,188.45,
"REM FORGN BODY SUB TIS SIMPLE",P960000007,CDM,960,RC,10120,HCPCS,Outpatient,,,592,296,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",136.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,141.20,59.98,280.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,88.97,86.90,106.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,80.36,80.36,80.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.26,136.26,
"REM FOREIGN BODY SUB TIS COMP",P960000008,CDM,960,RC,10121,HCPCS,Outpatient,,,1068,534,,,,,,,,0,other,"not separately reimbursement",,,,218.29,218.29,218.29,"1 through 10",other,"not separately reimbursement",244.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",244.78,244.78,
"DRAINAGE OF HEMATOMA/FLUID",P960000009,CDM,960,RC,10140,HCPCS,Outpatient,,,655,327.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",153.07,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.07,153.07,
"PUNCTURE DRAINAGE OF LESION",P960000010,CDM,960,RC,10160,HCPCS,Outpatient,,,508,254,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,393.75,393.75,393.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,315.00,315.00,315.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,102.65,102.65,102.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,401.79,401.79,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.32,117.32,
"DEBRIDE INFECTED SKIN",P960000011,CDM,960,RC,11000,HCPCS,Outpatient,,,217,108.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.06,51.06,
"DEBRIDE GENITALIA & PERINEUM",P960000012,CDM,960,RC,11004,HCPCS,Outpatient,,,2313,1156.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",525.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",525.43,525.43,
"DEBRIDE SKIN MUSC AT FX SITE",P960000013,CDM,960,RC,11011,HCPCS,Outpatient,,,2088,1044,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",474.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",474.33,474.33,
"DEB SUBQ TISSUE 20 SQ CM/<",P960000014,CDM,960,RC,11042,HCPCS,Outpatient,,,474,237,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",112.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,127.89,29.52,189.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,73.55,73.55,73.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,109.46,109.46,109.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.76,112.76,
"DEBRIDE TISSUE/MUSCLE",P960000015,CDM,960,RC,11043,HCPCS,Outpatient,,,905,452.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",209.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,114.37,114.37,114.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",209.49,209.49,
"DEB BONE 20 SQ CM/<",P960000016,CDM,960,RC,11044,HCPCS,Outpatient,,,1231,615.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",282.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,285.82,285.82,285.82,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,176.42,176.42,176.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.86,282.86,
"DEB SUBQ TISSUE ADD-ON",P960000017,CDM,960,RC,11045,HCPCS,Outpatient,,,162,81,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.45,37.45,
"DEB MUSC/FASCIA ADD-ON",P960000018,CDM,960,RC,11046,HCPCS,Outpatient,,,288,144,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,201.06,201.06,201.06,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.71,66.71,
"DEB BONE ADD-ON",P960000019,CDM,960,RC,11047,HCPCS,Outpatient,,,243,121.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",110.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,76.18,76.18,76.18,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",110.93,110.93,
"TRIM SKIN LESION",P960000020,CDM,960,RC,11055,HCPCS,Outpatient,,,92,46,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,73.60,28.32,73.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,52.93,52.93,52.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,13.41,13.41,13.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.2,56.2,
"TRIM SKIN LESIONS, 2 TO 4",P960000021,CDM,960,RC,11056,HCPCS,Outpatient,,,112,56,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,112.00,112.00,112.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,150.03,150.03,150.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.34,66.34,
"TANGNTL BX SKIN SINGLE LES",P960000022,CDM,960,RC,11102,HCPCS,Outpatient,,,199,99.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",89.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,80.73,80.73,80.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,87.99,87.99,87.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.58,89.58,
"REMOVAL OF SKIN TAGS",P960000023,CDM,960,RC,11200,HCPCS,Outpatient,,,171,85.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",79.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,119.56,98.83,140.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,68.84,68.84,68.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,496.86,496.86,496.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",79.74,79.74,
"SHAVE TRUNK <0.5 CM",P960000024,CDM,960,RC,11300,HCPCS,Outpatient,,,188,94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",89.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.21,36.21,36.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.65,89.65,
"SHAVE TRUNK 0.6-1 CM",P960000025,CDM,960,RC,11301,HCPCS,Outpatient,,,232,116,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",109.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",109.06,109.06,
"SHAVE TRUNK 1.1-2 CM",P960000026,CDM,960,RC,11302,HCPCS,Outpatient,,,273,136.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",126.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,69.26,69.26,69.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.09,126.09,
"SHAVE TRUNK >2 CM",P960000027,CDM,960,RC,11303,HCPCS,Outpatient,,,302,151,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",138.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.91,138.91,
"SHAVE S,N,H <0.5 CM",P960000028,CDM,960,RC,11305,HCPCS,Outpatient,,,191,95.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",94.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,143.51,143.51,143.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,94.49,94.49,94.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.54,94.54,
"SHAVE S,N,H 0.6-1 CM",P960000029,CDM,960,RC,11306,HCPCS,Outpatient,,,236,118,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",110.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",110.73,110.73,
"SHAVE S,N,H 1.1-2 CM",P960000030,CDM,960,RC,11307,HCPCS,Outpatient,,,278,139,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",129.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",129.49,129.49,
"SHAVE F,E,E,N,L,M <0.5 CM",P960000031,CDM,960,RC,11310,HCPCS,Outpatient,,,219,109.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",103.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.93,41.93,41.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.86,103.86,
"SHAVE F,E,E,N,L,M 0.6-1 CM",P960000032,CDM,960,RC,11311,HCPCS,Outpatient,,,214,107,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,181.90,181.90,181.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.35,123.35,
"SHAVE F,E,E,N,L,M 1-2 CM",P960000033,CDM,960,RC,11312,HCPCS,Outpatient,,,310,155,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",142.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.67,142.67,
"SHAVE F,E,E,N,L,M >2 CM",P960000034,CDM,960,RC,11313,HCPCS,Outpatient,,,360,180,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",166.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",166.76,166.76,
"EXC TR-EXT B9 MARG 0.5 < CM",P960000035,CDM,960,RC,11400,HCPCS,Outpatient,,,238,119,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",112.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,54.40,54.40,54.40,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.65,112.65,
"EXC TR-EXT B9 MARG 0.6-1 CM",P960000036,CDM,960,RC,11401,HCPCS,Outpatient,,,287,143.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",137.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.31,63.29,109.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,28.99,28.99,28.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.45,137.45,
"EXC TR-EXT B9 MARG 1.1-2 CM",P960000037,CDM,960,RC,11402,HCPCS,Outpatient,,,319,159.5,,,,,,,,0,other,"not separately reimbursement",,,,119.90,119.90,119.90,"1 through 10",other,"not separately reimbursement",152.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,188.98,64.57,213.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,112.94,112.94,112.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,127.19,95.01,143.72,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,32.05,32.05,32.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",152.46,152.46,
"EXC TR-EXT B9 MARG 2.1-3 CM",P960000038,CDM,960,RC,11403,HCPCS,Outpatient,,,370,185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",175.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,215.35,72.77,244.89,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,147.38,65.59,147.63,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,37.13,37.13,37.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.92,175.92,
"EXC TR-EXT B9 MARG 3.1-4 CM",P960000039,CDM,960,RC,11404,HCPCS,Outpatient,,,420,210,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",199.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,235.57,161.75,309.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.86,91.01,158.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",199.64,199.64,
"EXC TR-EXT B9 MARG > 4.0 CM",P960000040,CDM,960,RC,11406,HCPCS,Outpatient,,,607,303.5,,,,,,,,0,other,"not separately reimbursement",,,,1417.11,1417.11,1417.11,"1 through 10",other,"not separately reimbursement",285.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,264.78,206.23,327.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,232.08,232.08,232.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1277.44,1277.44,1277.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1629.39,1629.39,1629.39,"1 through 10",other,"not separately reimbursment",,,,1545.16,1545.16,1545.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",285.29,285.29,
"EXC H-F-NK-SP B9 MARG 0.5 <",P960000041,CDM,960,RC,11420,HCPCS,Outpatient,,,236,118,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",113.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",113.82,113.82,
"EXC H-F-NK-SP B9 MARG 0.6-1",P960000042,CDM,960,RC,11421,HCPCS,Outpatient,,,302,151,,,,,,,,0,other,"not separately reimbursement",,,,151.91,151.91,151.91,"1 through 10",other,"not separately reimbursement",143.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.49,143.49,
"EXC H-F-NK-SP B9 MARG 1.1-2",P960000043,CDM,960,RC,11422,HCPCS,Outpatient,,,338,169,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",161.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,150.51,150.51,150.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,69.39,18.42,120.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,161.94,161.94,161.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",161.31,161.31,
"EXC H-F-NK-SP B9+MARG 2.1-3",P960000044,CDM,960,RC,11423,HCPCS,Outpatient,,,389,194.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",183.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.52,183.52,
"EXC H-F-NK-SP B9 MARG 3.1-4",P960000045,CDM,960,RC,11424,HCPCS,Outpatient,,,452,226,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,82.44,82.44,82.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.73,211.73,
"EXC H-F-NK-SP B9 MARG > 4 CM",P960000046,CDM,960,RC,11426,HCPCS,Outpatient,,,647,323.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",303.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,326.84,246.84,406.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,201.31,201.31,201.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.53,303.53,
"EXC FACE-MM B9 MARG 0.5 < CM",P960000047,CDM,960,RC,11440,HCPCS,Outpatient,,,258,129,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",125.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.46,125.46,
"EXC FACE-MM B9 MARG 0.6-1 CM",P960000048,CDM,960,RC,11441,HCPCS,Outpatient,,,323,161.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",154.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,58.70,58.70,58.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",154.17,154.17,
"EXC FACE-MM B9 MARG 1.1-2 CM",P960000049,CDM,960,RC,11442,HCPCS,Outpatient,,,362,181,,,,,,,,0,other,"not separately reimbursement",,,,64.02,64.02,64.02,"1 through 10",other,"not separately reimbursement",171.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,262.19,262.19,262.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,132.95,132.95,132.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,143.41,36.45,143.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",171.43,171.43,
"EXC FACE-MM B9 MARG 2.1-3 CM",P960000050,CDM,960,RC,11443,HCPCS,Outpatient,,,433,216.5,,,,,,,,0,other,"not separately reimbursement",,,,210.06,210.06,210.06,"1 through 10",other,"not separately reimbursement",203.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,166.91,67.68,266.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,165.96,165.96,165.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,170.15,170.15,170.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.87,42.87,42.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",203.75,203.75,
"EXC FACE-MM B9 MARG 3.1-4 CM",P960000051,CDM,960,RC,11444,HCPCS,Outpatient,,,545,272.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",255.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1277.44,1277.44,1277.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,179.75,179.75,179.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",255.5,255.5,
"EXC TR-EXT MLG MARG 0.6-1 CM",P960000052,CDM,960,RC,11601,HCPCS,Outpatient,,,441,220.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",206.07,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",206.07,206.07,
"EXC TR-EXT MLG MARG 1.1-2 CM",P960000053,CDM,960,RC,11602,HCPCS,Outpatient,,,479,239.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",222.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,181.49,181.49,181.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",222.11,222.11,
"EXC TR-EXT MLG MARG 2.1-3 CM",P960000054,CDM,960,RC,11603,HCPCS,Outpatient,,,548,274,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",253.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,52.21,52.21,52.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,211.73,211.73,211.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,207.22,207.22,207.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",253.22,253.22,
"EXC TR-EXT MLG MARG 3.1-4 CM",P960000055,CDM,960,RC,11604,HCPCS,Outpatient,,,609,304.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",282.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,395.84,395.84,395.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.20,48.54,147.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,40.28,40.28,40.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.25,282.25,
"EXC TR-EXT MLG LES MARG > 4 CM",P960000056,CDM,960,RC,11606,HCPCS,Outpatient,,,873,436.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",404,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,377.03,377.03,377.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,237.37,237.37,237.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",404,404,
"EXC H-F-NK-SP MLG MARG 0.6-1",P960000057,CDM,960,RC,11621,HCPCS,Outpatient,,,444,222,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",206.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,311.38,311.38,311.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",206.94,206.94,
"EXC H-F-NK-SP MLG MARG 1.1-2",P960000058,CDM,960,RC,11622,HCPCS,Outpatient,,,495,247.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",229.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,187.48,187.48,187.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.24,47.24,47.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",229.4,229.4,
"EXC H-F-NK-SP MLG MARG 2.1-3",P960000059,CDM,960,RC,11623,HCPCS,Outpatient,,,582,291,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",269.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,166.28,123.30,209.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,163.70,163.70,163.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",269.45,269.45,
"EXC H-F-NK-SP MLG MAR > 4 CM",P960000060,CDM,960,RC,11626,HCPCS,Outpatient,,,791,395.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",367.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",367.62,367.62,
"EXC FACE-MM MALIG MARG 0.6-1",P960000061,CDM,960,RC,11641,HCPCS,Outpatient,,,459,229.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",214.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,175.51,175.51,175.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,44.22,44.22,44.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",214.23,214.23,
"EXC FACE-MM MALIG MARG 1.1-2",P960000062,CDM,960,RC,11642,HCPCS,Outpatient,,,525,262.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",243.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,25.06,25.06,25.06,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,223.55,205.91,241.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,167.89,87.71,198.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,50.12,50.12,50.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.14,243.14,
"EXC FACE-MM MALIG MARG 2.1-3",P960000063,CDM,960,RC,11643,HCPCS,Outpatient,,,620,310,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",286.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,234.96,234.96,234.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",286.51,286.51,
"EXC FACE-MM MALIG MARG 3.1-4",P960000064,CDM,960,RC,11644,HCPCS,Outpatient,,,764,382,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",353.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,261.52,261.52,261.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",353.28,353.28,
"EXC FACE-MM MLG MARG > 4 CM",P960000065,CDM,960,RC,11646,HCPCS,Outpatient,,,1001,500.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",460.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.37,460.37,
"TRIM NAIL(S)",P960000066,CDM,960,RC,11719,HCPCS,Outpatient,,,27,13.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,13.17,13.17,13.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,17.33,17.33,17.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.17,10.17,
"DEBRIDE NAIL, 1-5",P960000067,CDM,960,RC,11720,HCPCS,Outpatient,,,62,31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,39.36,35.75,52.03,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.60,10.60,10.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.48,23.48,
"DEBRIDE NAIL 6 OR MORE",P960000068,CDM,960,RC,11721,HCPCS,Outpatient,,,87,43.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,48.15,42.21,70.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,38.80,10.89,41.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.65,32.65,
"REMOVAL OF NAIL PLATE",P960000069,CDM,960,RC,11730,HCPCS,Outpatient,,,203,101.5,,,,,,,,0,other,"not separately reimbursement",,,,251.01,251.01,251.01,"1 through 10",other,"not separately reimbursement",79.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,103.16,101.43,139.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,104.25,104.25,104.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,106.38,87.76,106.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,44.91,44.91,53.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,99.88,92.76,107.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",79.31,79.31,
"REMOVE NAIL PLATE, ADD-ON",P960000070,CDM,960,RC,11732,HCPCS,Outpatient,,,62,31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,44.67,37.93,51.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.06,24.06,
"DRAIN BLOOD FROM UNDER NAIL",P960000071,CDM,960,RC,11740,HCPCS,Outpatient,,,95,47.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,52.46,52.46,52.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,190.95,190.95,190.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.29,38.29,
"REMOVAL OF NAIL BED",P960000072,CDM,960,RC,11750,HCPCS,Outpatient,,,296,148,,,,,,,,0,other,"not separately reimbursement",,,,49.84,49.84,49.84,"1 through 10",other,"not separately reimbursement",112.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,193.24,193.24,193.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,87.25,87.25,87.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,77.09,77.09,77.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.57,112.57,
"EXCISION OF NAIL FOLD, TOE",P960000073,CDM,960,RC,11765,HCPCS,Outpatient,,,322,161,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",121.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,194.20,138.22,207.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,75.50,75.50,75.50,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",121.01,121.01,
"REMOVAL PILONIDAL LESION EXT",P960000074,CDM,960,RC,11771,HCPCS,Outpatient,,,1106,553,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",541.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2878.22,2878.22,2878.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.58,541.58,
"REMOVAL PILONIDAL LESION COMP",P960000075,CDM,960,RC,11772,HCPCS,Outpatient,,,1340,670,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",656.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",656.49,656.49,
"INSERT DRUG IMPLANT DEVICE",P960000076,CDM,960,RC,11981,HCPCS,Outpatient,,,273,136.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,159.80,159.80,159.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,40.50,40.50,40.50,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93,93,
"REMOVE DRUG IMPLANT DEVICE",P960000077,CDM,960,RC,11982,HCPCS,Outpatient,,,310,155,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",105.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,103.48,103.48,103.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",105.64,105.64,
"REMOVE/INSERT DRUG IMPLANT",P960000078,CDM,960,RC,11983,HCPCS,Outpatient,,,441,220.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",130.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.92,130.92,
"LACERATION <2.5CM",P960000079,CDM,960,RC,12001,HCPCS,Outpatient,,,173,86.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",81.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,83.40,72.84,93.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,74.49,74.49,74.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,195.69,159.89,287.51,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,202.37,146.93,257.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.14,81.14,
"REP SUPERFICIAL WND(S) 2.6-7.5",P960000080,CDM,960,RC,12002,HCPCS,Outpatient,,,210,105,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",99.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,123.47,123.47,123.47,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.73,83.73,83.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,159.89,159.89,253.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,440.57,440.57,440.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",99.27,99.27,
"REP SUPERFICIAL WND(S)7.6-12.5",P960000081,CDM,960,RC,12004,HCPCS,Outpatient,,,247,123.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",116,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,220.44,172.00,268.88,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",116,116,
"LAYER CLOSURE OF WND <2.5CM",P960000082,CDM,960,RC,12031,HCPCS,Outpatient,,,457,228.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",226.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,393.75,393.75,393.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,315.00,315.00,315.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,147.37,183.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,401.79,401.79,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",226.25,226.25,
"LAYER CLOSE WND 2.6-7.5 SCALP",P960000083,CDM,960,RC,12032,HCPCS,Outpatient,,,584,292,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",271.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,358.40,249.39,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,184.57,155.10,351.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",271.63,271.63,
"LAYER CLOSE WND 7.6-12.5 SCALP",P960000084,CDM,960,RC,12034,HCPCS,Outpatient,,,602,301,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",291.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,447.48,447.48,447.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,315.00,220.50,367.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,183.14,183.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,241.08,112.50,369.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",291.63,291.63,
"LAYER CLOSE OF WND 12.6-20 INT",P960000085,CDM,960,RC,12035,HCPCS,Outpatient,,,734,367,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",346.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,393.75,393.75,393.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,183.14,183.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",346.93,346.93,
"LAYER CLOSURE OF WND 20.1-30",P960000086,CDM,960,RC,12036,HCPCS,Outpatient,,,812,406,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",387.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",387.44,387.44,
"LAYER CLOSURE OF WND 2.6-7.5",P960000087,CDM,960,RC,12042,HCPCS,Outpatient,,,558,279,,,,,,,,0,other,"not separately reimbursement",,,,402.88,402.88,402.88,"1 through 10",other,"not separately reimbursement",270.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,315.00,315.00,384.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,161.68,183.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,80.36,80.36,80.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",270.2,270.2,
"LAYER CLOSURE OF WND 7.6-12.5",P960000088,CDM,960,RC,12044,HCPCS,Outpatient,,,692,346,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",334.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,482.62,482.62,482.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",334.25,334.25,
"LAYER CLOSURE OF WND 12.6-20",P960000089,CDM,960,RC,12051,HCPCS,Outpatient,,,497,248.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",244.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,315.00,315.00,315.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,146.08,256.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,401.79,401.79,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",244.23,244.23,
"LAYER CLOSURE OF WND 2.6-5.0",P960000090,CDM,960,RC,12052,HCPCS,Outpatient,,,568,284,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",274.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,393.75,393.75,393.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,358.40,315.00,401.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.14,154.52,183.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,241.08,112.50,369.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.33,274.33,
"LAYER CLOSUR WND SCALP 12.6-20",P960000091,CDM,960,RC,12055,HCPCS,Outpatient,,,900,450,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",437.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",437.9,437.9,
"REPAIR OF WOUND/LESION 2.6-7.5",P960000092,CDM,960,RC,13121,HCPCS,Outpatient,,,824,412,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",387.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",387.39,387.39,
"REPAIR WOUND/LESION ADD-ON",P960000093,CDM,960,RC,13122,HCPCS,Outpatient,,,258,129,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",118.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",118.25,118.25,
"REPAIR OF WOUND/LESION COMPLEX",P960000094,CDM,960,RC,13131,HCPCS,Outpatient,,,744,372,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",351.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",351.46,351.46,
"SKIN TISSUE REARRANGEMENT",P960000095,CDM,960,RC,14040,HCPCS,Outpatient,,,1479,739.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",682.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",682.93,682.93,
"SKIN SPLIT GRAFT",P960000096,CDM,960,RC,15120,HCPCS,Outpatient,,,1653,826.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",768.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",768.39,768.39,
"SKIN FULL GRAFT",P960000097,CDM,960,RC,15260,HCPCS,Outpatient,,,1970,985,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",903.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",903.97,903.97,
"SKIN SUB GRAFT TRNK/ARM/LEG",P960000098,CDM,960,RC,15271,HCPCS,Outpatient,,,271,135.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",135.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,244.21,244.21,244.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",135.27,135.27,
"SKIN SUB GRAFT T/A/L ADD-ON",P960000099,CDM,960,RC,15272,HCPCS,Outpatient,,,53,26.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.6,23.6,
"SKIN SUB GRAFT FACE/NK/HF/G",P960000100,CDM,960,RC,15275,HCPCS,Outpatient,,,290,145,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",142.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,251.65,251.65,251.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.15,142.15,
"REMOVAL OF SUTR/STAP REQ ANEST",P960000101,CDM,960,RC,15851,HCPCS,Outpatient,,,190,95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",92.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",92.67,92.67,
"DRESSING CHANGE,NOT FOR BURN",P960000102,CDM,960,RC,15852,HCPCS,Outpatient,,,93,46.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.45,42.45,
"DRESS CHG OR DEBRID",P960000103,CDM,960,RC,16020,HCPCS,Outpatient,,,158,79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",74.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,159.91,68.49,251.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.04,74.04,
"DESTROY BENIGN/PREMLG LESION",P960000104,CDM,960,RC,17000,HCPCS,Outpatient,,,128,64,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,51.73,20.55,82.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,31.23,31.23,31.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,50.59,25.30,50.59,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,6.37,6.37,6.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.6,58.6,
"DESTROY LESIONS, 2-14",P960000105,CDM,960,RC,17003,HCPCS,Outpatient,,,11,5.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1.24,1.24,1.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,6.06,6.06,6.06,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.90,4.90,4.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1.24,1.24,1.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.41,5.41,
"DESTRUCT LESION, 1-14",P960000106,CDM,960,RC,17110,HCPCS,Outpatient,,,212,106,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",100,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,141.67,127.45,181.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.47,83.47,83.47,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,96.27,96.27,96.27,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,21.03,21.03,21.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100,100,
"CHEMICAL CAUTERY, TISSUE",P960000107,CDM,960,RC,17250,HCPCS,Outpatient,,,151,75.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",76.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,94.23,45.96,111.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,70.03,20.17,72.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.04,76.04,
"DESTRUCT SKIN LESION",P960000108,CDM,960,RC,17280,HCPCS,Outpatient,,,271,135.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",124.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",124.82,124.82,
"DESTRUCT SKIN LESIONS 0.6-1.0",P960000109,CDM,960,RC,17281,HCPCS,Outpatient,,,344,172,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",160.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.5,160.5,
"DESTRUCT SKIN LESIONS 1.1-2.0",P960000110,CDM,960,RC,17282,HCPCS,Outpatient,,,395,197.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",184.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",184.48,184.48,
"CRYOTHERAPY OF SKIN",P960000111,CDM,960,RC,17340,HCPCS,Outpatient,,,101,50.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.65,47.65,
"DRAINAGE OF BREAST LESION",P960000112,CDM,960,RC,19000,HCPCS,Outpatient,,,217,108.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",98.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,459.76,459.76,459.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,448.41,448.41,448.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.12,98.12,
"BX BREAST PERCUT W/O IMAGE",P960000113,CDM,960,RC,19100,HCPCS,Outpatient,,,289,144.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",137.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.73,137.73,
"BIOPSY OF BREAST, OPEN",P960000114,CDM,960,RC,19101,HCPCS,Outpatient,,,657,328.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",301.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",301.19,301.19,
"REMOVAL OF BREAST LESION",P960000115,CDM,960,RC,19120,HCPCS,Outpatient,,,958,479,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",454.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",454.11,454.11,
"EXCISION, BREAST LESION",P960000116,CDM,960,RC,19125,HCPCS,Outpatient,,,1062,531,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",501.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",501.59,501.59,
"EXCISION, ADDL BREAST LESION",P960000117,CDM,960,RC,19126,HCPCS,Outpatient,,,321,160.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",146.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.18,146.18,
"MAST, SIMPLE, COMPLETE",P960000118,CDM,960,RC,19303,HCPCS,Outpatient,,,1988,994,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",869.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",869.32,869.32,
"MAST, MOD RAD",P960000119,CDM,960,RC,19307,HCPCS,Outpatient,,,2847.08,1423.54,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1092.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1092.28,1092.28,
"INJ TENDON SHEATH/LIGAMENT",P960000120,CDM,960,RC,20550,HCPCS,Outpatient,,,103,51.5,,,,,,,,0,other,"not separately reimbursement",,,,57.19,57.19,57.19,"1 through 10",other,"not separately reimbursement",47.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,71.48,33.66,87.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,137.85,28.85,277.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.2,47.2,
"INJECT TENDON ORIGIN/INSERT",P960000121,CDM,960,RC,20551,HCPCS,Outpatient,,,118,59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.4,48.4,
"INJECT TRIGGER POINT, 1 OR 2",P960000122,CDM,960,RC,20552,HCPCS,Outpatient,,,107,53.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.95,47.95,
"DRAIN/INJECT, SM JOINT/BURSA",P960000123,CDM,960,RC,20600,HCPCS,Outpatient,,,93,46.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,67.11,20.53,80.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",43.46,43.46,
"DRAIN/INJECT INTER JOINT/BURSA",P960000124,CDM,960,RC,20605,HCPCS,Outpatient,,,98,49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,87.60,87.60,87.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,136.61,59.70,213.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.99,44.99,
"DRAIN/INJ JOINT/BURSA W/O US",P960000125,CDM,960,RC,20610,HCPCS,Outpatient,,,118,59,,,,,,,,0,other,"not separately reimbursement",,,,40.83,40.83,40.83,"1 through 10",other,"not separately reimbursement",53.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,56.92,12.25,81.97,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.90,30.03,144.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.04,48.04,232.74,47,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,51.59,43.48,58.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,290.93,290.93,290.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.31,53.31,
"REM SUPPORT IMPLANT SUPERFICIA",P960000126,CDM,960,RC,20670,HCPCS,Outpatient,,,726,363,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",315.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,371.25,371.25,371.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.8,315.8,
"REM SUPPORT IMPLANT DEEP",P960000127,CDM,960,RC,20680,HCPCS,Outpatient,,,1197,598.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",528.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,183.28,183.28,183.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,352.52,352.52,352.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",528.18,528.18,
"APPLY BONE FIXATION DEVICE",P960000128,CDM,960,RC,20690,HCPCS,Outpatient,,,1172,586,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",516.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",516.56,516.56,
"EXC NECK LES SC 3+ CM",P960000129,CDM,960,RC,21552,HCPCS,Outpatient,,,878,439,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",384.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",384.95,384.95,
"EXC BACK LES SC 3+ CM",P960000130,CDM,960,RC,21931,HCPCS,Outpatient,,,925,462.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",406.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,20.78,20.78,20.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,357.94,357.94,357.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.31,406.31,
"EXC BACK TUM DEEP < 5 CM",P960000131,CDM,960,RC,21932,HCPCS,Outpatient,,,1304,652,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",572.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.72,572.72,
"EXC SHOULDER LES SC > 3 CM",P960000132,CDM,960,RC,23071,HCPCS,Outpatient,,,824,412,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",362.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",362.73,362.73,
"REPAIR ROTATOR CUFF, CHRONIC",P960000133,CDM,960,RC,23412,HCPCS,Outpatient,,,1673,836.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",737.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",737.66,737.66,
"TREAT CLAVICLE FRACTURE",P960000134,CDM,960,RC,23515,HCPCS,Outpatient,,,1413,706.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",622.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",622.44,622.44,
"TREAT SHOULDER DISLOCATION",P960000135,CDM,960,RC,23655,HCPCS,Outpatient,,,781,390.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",348.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1261.80,310.48,1470.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",348.87,348.87,
"DRAINAGE OF ARM LESION",P960000136,CDM,960,RC,23930,HCPCS,Outpatient,,,685,342.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",306.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",306.48,306.48,
"DRAINAGE OF ARM BURSA",P960000137,CDM,960,RC,23931,HCPCS,Outpatient,,,551,275.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",248.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",248.53,248.53,
"REMOVAL OF ELBOW BURSA",P960000138,CDM,960,RC,24105,HCPCS,Outpatient,,,681,340.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",305.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",305.01,305.01,
"TREAT HUMERUS FRACTURE",P960000139,CDM,960,RC,24575,HCPCS,Outpatient,,,1438,719,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",633.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",633.4,633.4,
"TREAT ELBOW DISLOCATION",P960000140,CDM,960,RC,24605,HCPCS,Outpatient,,,914,457,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",408.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1609.45,1609.45,1609.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",408.73,408.73,
"TREAT ULNAR FRACTURE",P960000141,CDM,960,RC,24685,HCPCS,Outpatient,,,1279,639.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",564.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",564.67,564.67,
"DRAINAGE OF FOREARM LESION",P960000142,CDM,960,RC,25028,HCPCS,Outpatient,,,1016,508,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",511.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",511.34,511.34,
"REMOVE WRIST TENDON LESION",P960000143,CDM,960,RC,25111,HCPCS,Outpatient,,,623,311.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",277.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.19,277.19,
"REMOVAL OF FOREARM LESION",P960000144,CDM,960,RC,25120,HCPCS,Outpatient,,,972,486,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",432.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",432.63,432.63,
"TREAT FRACTURE OF ULNA W/MANI",P960000145,CDM,960,RC,25535,HCPCS,Outpatient,,,946,473,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",422.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",422.37,422.37,
"TREAT FRACTURE OF ULNA OPEN",P960000146,CDM,960,RC,25545,HCPCS,Outpatient,,,1219,609.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",537.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",537.91,537.91,
"TREAT FRACTURE RADIUS & ULNA",P960000147,CDM,960,RC,25574,HCPCS,Outpatient,,,1320,660,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",582.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",582.1,582.1,
"TREAT FRACTURE RADIUS/ULNA",P960000148,CDM,960,RC,25575,HCPCS,Outpatient,,,1768,884,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",779.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",779.47,779.47,
"TREAT FRAC RADIUS/ULNA W/MANIP",P960000149,CDM,960,RC,25605,HCPCS,Outpatient,,,1054,527,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",466.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,629.80,629.80,629.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1261.80,1261.80,1261.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,644.33,644.33,644.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",466.58,466.58,
"TREAT FX DISTAL RADIAL",P960000150,CDM,960,RC,25606,HCPCS,Outpatient,,,1295,647.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",572.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.65,572.65,
"TREAT FX RAD EXTRA-ARTICUL",P960000151,CDM,960,RC,25607,HCPCS,Outpatient,,,1439,719.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",635.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",635.73,635.73,
"TREAT FX RAD INTRA-ARTICUL",P960000152,CDM,960,RC,25608,HCPCS,Outpatient,,,1615,807.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",713.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",713.19,713.19,
"TREAT FX RADIAL 3+ FRAG",P960000153,CDM,960,RC,25609,HCPCS,Outpatient,,,2056,1028,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",907.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",907.67,907.67,
"RELEASE PALM CONTRACTURE",P960000154,CDM,960,RC,26040,HCPCS,Outpatient,,,606,303,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",270.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",270.22,270.22,
"INCISE FINGER TENDON SHEATH",P960000155,CDM,960,RC,26055,HCPCS,Outpatient,,,1068,534,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",468.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.04,468.04,
"REMOVE TENDON SHEATH LESION",P960000156,CDM,960,RC,26160,HCPCS,Outpatient,,,1099,549.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",489.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",489.79,489.79,
"REPAIR HAND JOINT",P960000157,CDM,960,RC,26540,HCPCS,Outpatient,,,1259,629.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",579.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",579.48,579.48,
"TREAT METACARPAL FRAC PERCUTAN",P960000158,CDM,960,RC,26608,HCPCS,Outpatient,,,926,463,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",413.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",413.93,413.93,
"TREAT METACARPAL FRAC OPEN",P960000159,CDM,960,RC,26615,HCPCS,Outpatient,,,1124,562,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",496.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.57,496.57,
"TREAT FINGER FRAC CLOSED",P960000160,CDM,960,RC,26720,HCPCS,Outpatient,,,381,190.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",169.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.7,169.7,
"TREAT FINGER FRAC PERCUTANEOUS",P960000161,CDM,960,RC,26727,HCPCS,Outpatient,,,913,456.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",406.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",406.94,406.94,
"TREAT FINGER FRAC OPEN",P960000162,CDM,960,RC,26735,HCPCS,Outpatient,,,1165,582.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",513.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",513.51,513.51,
"FINGER FRAC CLOSED ARTICULAR",P960000163,CDM,960,RC,26740,HCPCS,Outpatient,,,443,221.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",197.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.86,197.86,
"PIN FINGER FRACTURE, EACH",P960000164,CDM,960,RC,26756,HCPCS,Outpatient,,,810,405,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",363.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",363.66,363.66,
"TREAT FINGER FRAC OPEN INTERN",P960000165,CDM,960,RC,26765,HCPCS,Outpatient,,,976,488,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",432.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",432.76,432.76,
"AMPUTATION OF FINGER/THUMB",P960000166,CDM,960,RC,26951,HCPCS,Outpatient,,,1248,624,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",573.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",573.86,573.86,
"DRAINAGE OF PELVIS LESION",P960000167,CDM,960,RC,26990,HCPCS,Outpatient,,,1225,612.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",564.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",564.87,564.87,
"TX THIGH FRACTURE PERCUTANEOUS",P960000168,CDM,960,RC,27235,HCPCS,Outpatient,,,1790,895,,,,,,,,0,other,"not separately reimbursement",,,,722.53,722.53,722.53,"1 through 10",other,"not separately reimbursement",785.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1365.17,1365.17,1365.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,680.03,680.03,680.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.04,47.04,47.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.83,785.83,
"TX THIGH FRACTURE OPEN",P960000169,CDM,960,RC,27236,HCPCS,Outpatient,,,2359,1179.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1034.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1034.68,1034.68,
"TX THIGH FRACTURE WITH PLATE",P960000170,CDM,960,RC,27244,HCPCS,Outpatient,,,2428,1214,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1064.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1064.8,1064.8,
"TX THIGH FRAC W OR W/OUT SCREW",P960000171,CDM,960,RC,27245,HCPCS,Outpatient,,,2428,1214,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1063.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,917.03,917.03,917.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,63.71,63.71,63.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1063.84,1063.84,
"TX HIP DISLOC W/ANESTH",P960000172,CDM,960,RC,27252,HCPCS,Outpatient,,,1490,745,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",653.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",653.74,653.74,
"TX HIP DISLOC REG./GEN ANESTH",P960000173,CDM,960,RC,27266,HCPCS,Outpatient,,,1138,569,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",503.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1609.45,1609.45,1609.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",503.46,503.46,
"DRAIN THIGH/KNEE LESION",P960000174,CDM,960,RC,27301,HCPCS,Outpatient,,,1302,651,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",581.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",581.53,581.53,
"REMOVAL OF KNEE CYST",P960000175,CDM,960,RC,27345,HCPCS,Outpatient,,,938,469,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",417.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.65,417.65,
"TOTAL KNEE ARTHROPLASTY",P960000176,CDM,960,RC,27447,HCPCS,Outpatient,,,3085.93,1542.965,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1173.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1173.22,1173.22,
"TREATMENT OF THIGH FRACTURE",P960000177,CDM,960,RC,27506,HCPCS,Outpatient,,,2637,1318.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1157.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1157.82,1157.82,
"TREAT KNEECAP FRACTURE",P960000178,CDM,960,RC,27524,HCPCS,Outpatient,,,1476,738,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",651.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7292.74,7292.74,7292.74,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",651.17,651.17,
"TREAT KNEE FRACTURE OPEN",P960000179,CDM,960,RC,27535,HCPCS,Outpatient,,,1769,884.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",777.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",777.95,777.95,
"TREAT KNEE FRACTURE BICONDYLAR",P960000180,CDM,960,RC,27536,HCPCS,Outpatient,,,2344,1172,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1028.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1028.78,1028.78,
"TREAT KNEECAP DISLOCATION",P960000181,CDM,960,RC,27562,HCPCS,Outpatient,,,928,464,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",419.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,109.21,109.21,109.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",419.64,419.64,
"AMPUTATE LEG AT THIGH",P960000182,CDM,960,RC,27590,HCPCS,Outpatient,,,1590,795,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",686.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",686.19,686.19,
"DECOMPRESSION OF LOWER LEG",P960000183,CDM,960,RC,27602,HCPCS,Outpatient,,,966,483,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",418.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",418.45,418.45,
"DRAIN LOWER LEG LESION",P960000184,CDM,960,RC,27603,HCPCS,Outpatient,,,1025,512.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",459.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",459.59,459.59,
"REPAIR ACHILLES TENDON",P960000185,CDM,960,RC,27650,HCPCS,Outpatient,,,1295,647.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",571,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,708.33,603.24,813.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7184.07,7184.07,7184.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",571,571,
"RPAIR ANKL LIGAMNT COLLAT-SNGL",P960000186,CDM,960,RC,27695,HCPCS,Outpatient,,,939,469.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",412.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",412.24,412.24,
"RPAIR ANKL LIGAMNT COLLAT-BOTH",P960000187,CDM,960,RC,27696,HCPCS,Outpatient,,,1093,546.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",486.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",486.72,486.72,
"TREATMENT OF TIBIA FRACTURE",P960000188,CDM,960,RC,27756,HCPCS,Outpatient,,,1129,564.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",496.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.75,496.75,
"TREAT OF ANKLE FRAC W/MANIPULA",P960000189,CDM,960,RC,27762,HCPCS,Outpatient,,,914,457,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",412.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,415.39,415.39,415.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",412.44,412.44,
"TREAT OF ANKLE FRAN OPEN MEDIA",P960000190,CDM,960,RC,27766,HCPCS,Outpatient,,,1193,596.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",522.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",522.46,522.46,
"TREAT OF ANKLE FRAC OPEN DISTA",P960000191,CDM,960,RC,27792,HCPCS,Outpatient,,,1280,640,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",560.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",560.08,560.08,
"TREAT OF ANKLE FRAC BIMALLEOLA",P960000192,CDM,960,RC,27814,HCPCS,Outpatient,,,1515,757.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",663.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3389.33,3389.33,3389.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",663.88,663.88,
"TREAT OF ANKLE FRAC TRIMALLEOL",P960000193,CDM,960,RC,27822,HCPCS,Outpatient,,,1684,842,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",749.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",749.33,749.33,
"TREAT LOWER LEG FRACTURE",P960000194,CDM,960,RC,27827,HCPCS,Outpatient,,,2158,1079,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",960.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",960.7,960.7,
"TREAT LOWER LEG JOINT",P960000195,CDM,960,RC,27829,HCPCS,Outpatient,,,1363,681.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",606.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",606.08,606.08,
"TREAT ANKLE DISLOCATION",P960000196,CDM,960,RC,27842,HCPCS,Outpatient,,,965,482.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",425.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",425.88,425.88,
"AMPUTATION OF LOWER LEG",P960000197,CDM,960,RC,27880,HCPCS,Outpatient,,,1823,911.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",785.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.84,785.84,
"REM OF FT FOREIGN BODY SUBCU",P960000198,CDM,960,RC,28190,HCPCS,Outpatient,,,503,251.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",219.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,707.56,707.56,707.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",219.19,219.19,
"REM OF FT FOREIGN BODY DEEP",P960000199,CDM,960,RC,28192,HCPCS,Outpatient,,,923,461.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",408.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,622.66,622.66,622.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",408.05,408.05,
"REPAIR OF HAMMERTOE",P960000200,CDM,960,RC,28285,HCPCS,Outpatient,,,1055,527.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",468.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2558.14,2558.14,2558.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2005.91,2005.91,2005.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.05,468.05,
"PARTIAL REMOVAL OF FOOT BONE",P960000201,CDM,960,RC,28288,HCPCS,Outpatient,,,1188,594,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",530.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",530.61,530.61,
"REPAIR HALLUX RIGIDUS",P960000202,CDM,960,RC,28289,HCPCS,Outpatient,,,1468,734,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",621.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",621.31,621.31,
"CORRECTION OF BUNION",P960000203,CDM,960,RC,28296,HCPCS,Outpatient,,,1792,896,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",791,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3262.93,3262.93,3262.93,"1 through 10",other,"not separately reimbursment",,,,3403.28,3403.28,3403.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",791,791,
"INCISION OF METATARSAL",P960000204,CDM,960,RC,28308,HCPCS,Outpatient,,,1116,558,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",495.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.96,11.96,11.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.75,495.75,
"REPAIR DEFORMITY OF TOE",P960000205,CDM,960,RC,28313,HCPCS,Outpatient,,,1036,518,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",456.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",456.31,456.31,
"TREAT HEEL FRACTURE",P960000206,CDM,960,RC,28415,HCPCS,Outpatient,,,2214,1107,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",971.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",971.71,971.71,
"TREAT METATARSAL FRACTURE",P960000207,CDM,960,RC,28485,HCPCS,Outpatient,,,1068,534,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",480.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",480.45,480.45,
"REPAIR FOOT DISLOCATION",P960000208,CDM,960,RC,28555,HCPCS,Outpatient,,,1724,862,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",740.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",740.71,740.71,
"REPAIR TOE DISLOCATION",P960000209,CDM,960,RC,28645,HCPCS,Outpatient,,,1294,647,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",572.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.06,572.06,
"AMPUTATION THRU METATARSAL",P960000210,CDM,960,RC,28805,HCPCS,Outpatient,,,1458,729,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",631.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",631.41,631.41,
"AMPUTATION TOE & METATARSAL",P960000211,CDM,960,RC,28810,HCPCS,Outpatient,,,855,427.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",372.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",372.48,372.48,
"AMPUTATION OF TOE",P960000212,CDM,960,RC,28820,HCPCS,Outpatient,,,1109,554.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",485.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.59,80.77,2073.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",485.78,485.78,
"PARTIAL AMPUTATION OF TOE",P960000213,CDM,960,RC,28825,HCPCS,Outpatient,,,1059,529.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",464.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,126.27,51.64,160.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,131.29,131.29,131.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",464.59,464.59,
"APPLICATION OF LONG ARM CAST",P960000214,CDM,960,RC,29065,HCPCS,Outpatient,,,186,93,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,124.02,124.02,124.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,65.07,65.07,65.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,69.61,59.73,79.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",80.95,80.95,
"APPLICATION OF FOREARM CAST",P960000215,CDM,960,RC,29075,HCPCS,Outpatient,,,168,84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",72.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,57.78,16.38,128.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,66.93,59.43,77.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,74.38,74.38,74.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.95,72.95,
"APPLY HAND/WRIST CAST LOWER",P960000216,CDM,960,RC,29085,HCPCS,Outpatient,,,185,92.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",80.43,80.43,
"APPLY LONG ARM SPLINT",P960000217,CDM,960,RC,29105,HCPCS,Outpatient,,,171,85.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",69.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,76.14,64.84,87.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,447.48,447.48,447.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.40,103.26,158.68,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,326.48,223.53,468.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,158.68,158.68,158.68,"1 through 10",other,"not separately reimbursment",,,,91.81,91.81,91.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.4,69.4,
"APPLY FOREARM SPLINT",P960000218,CDM,960,RC,29125,HCPCS,Outpatient,,,125,62.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,70.13,42.13,99.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.07,55.83,64.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,268.14,187.70,468.79,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,269.28,269.28,269.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.56,54.56,
"APPLICATION OF FINGER SPLINT",P960000219,CDM,960,RC,29130,HCPCS,Outpatient,,,80,40,,,,,,,,0,other,"not separately reimbursement",,,,290.70,290.70,290.70,"1 through 10",other,"not separately reimbursement",35.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,49.93,44.39,55.47,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,156.01,34.67,269.52,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.41,35.41,
"STRAPPING OF HAND OR FINGER",P960000220,CDM,960,RC,29280,HCPCS,Outpatient,,,56,28,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,24.98,24.98,24.98,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.58,26.58,
"APPLICATION OF LONG LEG CAST",P960000221,CDM,960,RC,29345,HCPCS,Outpatient,,,265,132.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",115.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.36,83.36,83.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.35,115.35,
"LONG LEG CAST",P960000222,CDM,960,RC,29345,HCPCS,Outpatient,,,265,132.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",115.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.36,83.36,83.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.35,115.35,
"APPLY SHORT LEG CAST",P960000223,CDM,960,RC,29405,HCPCS,Outpatient,,,159,79.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",67.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,61.97,61.97,61.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.99,67.99,
"SHORT LEG CAST",P960000224,CDM,960,RC,29405,HCPCS,Outpatient,,,159,79.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",67.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,61.97,61.97,61.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.99,67.99,
"APPLICATION, LONG LEG SPLINT",P960000225,CDM,960,RC,29505,HCPCS,Outpatient,,,162,81,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",72.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.40,80.86,141.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,247.65,125.90,260.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,158.68,158.68,158.68,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.38,72.38,
"APPLICATION LOWER LEG SPLINT",P960000226,CDM,960,RC,29515,HCPCS,Outpatient,,,140,70,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",60.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,38.49,7.91,69.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,155.51,155.51,155.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.40,124.40,125.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,366.24,269.03,381.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,264.70,126.18,678.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.47,60.47,
"APPLICATION OF PASTE BOOT",P960000227,CDM,960,RC,29580,HCPCS,Outpatient,,,102,51,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,57.31,57.31,57.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.40,62.18,174.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.75,11.75,11.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.13,54.13,
"APPLY MULTLAY COMPRS LWR LEG",P960000228,CDM,960,RC,29581,HCPCS,Outpatient,,,119,59.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",76.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.40,124.40,124.40,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.84,76.84,
"SHLDER ARTHROSCOPY/SURG LIMIT",P960000229,CDM,960,RC,29822,HCPCS,Outpatient,,,1114,557,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",498.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3262.94,3237.34,3262.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",498.47,498.47,
"SHLDER ARTHROSCOPY/SURG EXT",P960000230,CDM,960,RC,29823,HCPCS,Outpatient,,,1216,608,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",542.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",542.51,542.51,
"SHLDER ARTHROSCOPY/SUR DECOMP",P960000231,CDM,960,RC,29826,HCPCS,Outpatient,,,414.57,207.285,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",151.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.5,151.5,
"ARTHROSCOP ROTATOR CUFF REPR",P960000232,CDM,960,RC,29827,HCPCS,Outpatient,,,2082,1041,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",926.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1169.18,1169.18,1169.18,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7184.07,7184.07,7184.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",926.79,926.79,
"KNEE ARTHR/SURG ARTICULAR",P960000233,CDM,960,RC,29877,HCPCS,Outpatient,,,1220,610,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",536.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",536.72,536.72,
"KNEE ARTHR/SURG MENISECTOMY",P960000234,CDM,960,RC,29880,HCPCS,Outpatient,,,1104,552,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",485.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,810.37,810.37,810.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3185.94,3185.94,3185.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",485.28,485.28,
"KNEE ARTHR/SURG DEBRIDEMENT",P960000235,CDM,960,RC,29881,HCPCS,Outpatient,,,1062,531,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",467.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,680.27,669.62,690.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,260.33,260.33,260.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",467.51,467.51,
"FOREIGN BODY-NOSE",P960000236,CDM,960,RC,30300,HCPCS,Outpatient,,,340,170,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",168.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,96.46,96.46,96.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,269.28,269.28,269.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.65,168.65,
"REMOVE FOREIGN BODY, LARYNX",P960000237,CDM,960,RC,31577,HCPCS,Outpatient,,,529,264.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",247.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.61,247.61,
"INCISION OF WINDPIPE",P960000238,CDM,960,RC,31605,HCPCS,Outpatient,,,367,183.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",302.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",302.28,302.28,
"DX BRONCHOSCOPE/BRUSH",P960000239,CDM,960,RC,31623,HCPCS,Outpatient,,,525,262.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",240.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.82,240.82,
"INSERTION OF CHEST TUBE",P960000240,CDM,960,RC,32551,HCPCS,Outpatient,,,315,157.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",142.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.56,142.56,
"ASPIRATE PLEURA W/O IMAGING",P960000241,CDM,960,RC,32554,HCPCS,Outpatient,,,390,195,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",198.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.32,198.32,
"ASPIRATE PLEURA W/ IMAGING",P960000242,CDM,960,RC,32555,HCPCS,Outpatient,,,559,279.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",277.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,609.31,609.31,609.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,487.44,487.44,487.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.36,124.36,124.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",277.44,277.44,
"INS HEART PCEMAKER VENTRICULAR",P960000243,CDM,960,RC,33207,HCPCS,Outpatient,,,954,477,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",403.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",403.5,403.5,
"INS HEART PCEMAKER ATRIAL&VENT",P960000244,CDM,960,RC,33208,HCPCS,Outpatient,,,1036,518,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",438.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",438.48,438.48,
"INSERTION OF HEART ELECTRODE",P960000245,CDM,960,RC,33210,HCPCS,Outpatient,,,331,165.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",137.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.77,137.77,
"REMV&REPLC PM GEN DUAL LEAD",P960000246,CDM,960,RC,33228,HCPCS,Outpatient,,,700,350,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",297.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",297.84,297.84,
"ELTRD/INSERT PACE-DEFIB",P960000247,CDM,960,RC,33249,HCPCS,Outpatient,,,1821,910.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",771.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",771.64,771.64,
"INSERT TUNNELED CV CATH",P960000248,CDM,960,RC,36561,HCPCS,Outpatient,,,2083,1041.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",891.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2481.58,2481.58,2481.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,262.23,262.23,262.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2856.97,2856.97,2856.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",891.31,891.31,
"REM TUNNELED CV CATH W/OUT SUB",P960000249,CDM,960,RC,36589,HCPCS,Outpatient,,,322,161,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,487.44,487.44,487.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2628.95,2628.95,2628.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.46,139.46,
"REM TUNNELED CV CATH WITH SUB",P960000250,CDM,960,RC,36590,HCPCS,Outpatient,,,434,217,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",186.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1224.77,1224.77,1224.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,35.61,35.61,35.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.7,186.7,
"BIO/REM, LYMPH NODE OPEN SUPER",P960000251,CDM,960,RC,38500,HCPCS,Outpatient,,,645,322.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",280.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",280.59,280.59,
"BIO/REM, LYMPH NODE DEEP CERV",P960000252,CDM,960,RC,38510,HCPCS,Outpatient,,,1015,507.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",439.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",439.76,439.76,
"EXCISION OF TONGUE LESION",P960000253,CDM,960,RC,41110,HCPCS,Outpatient,,,414,207,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",238.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.69,238.69,
"REMOVE TONSILS AND ADENOIDS",P960000254,CDM,960,RC,42820,HCPCS,Outpatient,,,571,285.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",315.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.02,315.02,
"REMOVAL OF TONSILS",P960000255,CDM,960,RC,42826,HCPCS,Outpatient,,,497,248.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",274.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",274.29,274.29,
"EGD BALLOON DIL ESOPH30 MM/>",P960000256,CDM,960,RC,43233,HCPCS,Outpatient,,,462,231,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",252.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",252.76,252.76,
"UPPR GI ENDOSCOPY, DIAGNOSIS",P960000257,CDM,960,RC,43235,HCPCS,Outpatient,,,494,247,,,,,,,,0,other,"not separately reimbursement",,,,71.04,71.04,71.04,"1 through 10",other,"not separately reimbursement",303.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,72.28,36.13,191.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,369.60,46.02,922.49,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,97.03,97.03,97.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,942.85,660.00,942.85,"1 through 10",other,"not separately reimbursment",,,,462.01,462.01,462.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",303.12,303.12,
"UPPER GI ENDOSCOPY, BIOPSY",P960000258,CDM,960,RC,43239,HCPCS,Outpatient,,,658,329,,,,,,,,0,other,"not separately reimbursement",,,,107.86,107.86,107.86,"1 through 10",other,"not separately reimbursement",403.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,74.06,25.90,116.35,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,63.45,63.03,114.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,102.77,51.39,739.19,45,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,280.32,33.88,702.98,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,942.85,641.14,942.85,"1 through 10",other,"not separately reimbursment",,,,569.74,287.56,851.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",403.63,403.63,
"PLACE GASTROSTOMY TUBE",P960000259,CDM,960,RC,43246,HCPCS,Outpatient,,,406,203,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",221.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,822.33,283.67,1360.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",221.34,221.34,
"OP UP GI ENDO WI REM FRGN BODY",P960000260,CDM,960,RC,43247,HCPCS,Outpatient,,,675,337.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",401.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,129.57,129.57,129.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",401.86,401.86,
"OP UP GI END W/REM TU/POLY/LES",P960000261,CDM,960,RC,43251,HCPCS,Outpatient,,,847,423.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",516.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1477.56,1477.56,1477.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",516.09,516.09,
"FREEING OF BOWEL ADHESION",P960000262,CDM,960,RC,44005,HCPCS,Outpatient,,,2173,1086.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1198.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1036.64,1036.64,1036.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1198.29,1198.29,
"REMOVAL OF SMALL INTESTINE",P960000263,CDM,960,RC,44120,HCPCS,Outpatient,,,2430,1215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1340.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1340.59,1340.59,
"PART REM COLON W/ANASTOMOSIS",P960000264,CDM,960,RC,44140,HCPCS,Outpatient,,,2664,1332,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1470.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.97,1470.97,
"PART REM COLON W/COLOSTOMY",P960000265,CDM,960,RC,44143,HCPCS,Outpatient,,,3306,1653,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1822.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1822.8,1822.8,
COLOSTOMY,P960000266,CDM,960,RC,44320,HCPCS,Outpatient,,,2385,1192.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1316.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1316.1,1316.1,
"SMALL BOWEL ENDOSCOPY",P960000267,CDM,960,RC,44380,HCPCS,Outpatient,,,322,161,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",197.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197.29,197.29,
"COLON ENDOSCOPY",P960000268,CDM,960,RC,44388,HCPCS,Outpatient,,,558,279,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",329.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",329.83,329.83,
"SUTURE, SMALL INTESTINE",P960000269,CDM,960,RC,44602,HCPCS,Outpatient,,,2807,1403.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1546.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1546.74,1546.74,
"REPAIR BOWEL OPENING/CLOSURE",P960000270,CDM,960,RC,44620,HCPCS,Outpatient,,,1725,862.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",949.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",949.82,949.82,
"REPAIR BOWEL OPENING/RESECTION",P960000271,CDM,960,RC,44626,HCPCS,Outpatient,,,3190,1595,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1754.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1754.29,1754.29,
"DRAIN APP ABSCESS, OPEN",P960000272,CDM,960,RC,44900,HCPCS,Outpatient,,,1521,760.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",857.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",857.28,857.28,
APPENDECTOMY,P960000273,CDM,960,RC,44950,HCPCS,Outpatient,,,1272,636,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",704.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",704.34,704.34,
"APPENDECTOMY ADD-ON",P960000274,CDM,960,RC,44955,HCPCS,Outpatient,,,168,84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.72,91.72,
"APPENDECTOMY RUPTURED",P960000275,CDM,960,RC,44960,HCPCS,Outpatient,,,1733,866.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",960.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",960.68,960.68,
"LAPAROSCOPY, APPENDECTOMY",P960000276,CDM,960,RC,44970,HCPCS,Outpatient,,,1188,594,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",657.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,758.81,570.04,767.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,450.86,370.17,550.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,531.18,510.26,653.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",657.74,657.74,
"DRAINAGE OF RECTAL ABSCESS",P960000277,CDM,960,RC,45005,HCPCS,Outpatient,,,531,265.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",316.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",316.23,316.23,
"PROCTOSIGMOIDOSCOPY DX",P960000278,CDM,960,RC,45300,HCPCS,Outpatient,,,237,118.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",133.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.5,133.5,
"PROCTOSIGMOIDOSCOPY W/BX",P960000279,CDM,960,RC,45305,HCPCS,Outpatient,,,275,137.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",175.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",175.34,175.34,
"PROCTOSIGMOIDOSCOPY REMOVAL",P960000280,CDM,960,RC,45309,HCPCS,Outpatient,,,320,160,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",204.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.54,204.54,
"DIAGNOSTIC SIGMOIDOSCOPY",P960000281,CDM,960,RC,45330,HCPCS,Outpatient,,,319,159.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",188.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,361.52,361.52,361.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.72,188.72,
"SIGMOIDOSCOPY AND BIOPSY",P960000282,CDM,960,RC,45331,HCPCS,Outpatient,,,489,244.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",296.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,21.95,21.95,21.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,57.60,57.60,57.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.78,296.78,
"SIGMOIDOSCOPY W/FB REMOVAL",P960000283,CDM,960,RC,45332,HCPCS,Outpatient,,,482,241,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",286.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",286.01,286.01,
"DIAGNOSTIC COLONOSCOPY",P960000284,CDM,960,RC,45378,HCPCS,Outpatient,,,307,153.5,,,,,,,,0,other,"not separately reimbursement",,,,237.28,237.28,237.28,"1 through 10",other,"not separately reimbursement",307,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,287.75,197.72,287.75,31,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,528.97,252.33,811.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,359.41,173.16,718.81,24,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,145.68,101.98,458.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,687.65,458.43,916.86,"1 through 10",other,"not separately reimbursment",,,,6058.14,5346.22,8561.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",307,307,
"COLONOSCOPY AND BIOPSY",P960000285,CDM,960,RC,45380,HCPCS,Outpatient,,,781,390.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",461.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,295.62,131.90,312.70,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1162.02,1162.02,1162.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,929.61,41.63,1108.41,33,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,672.95,261.18,1084.72,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1185.74,1185.74,1185.74,"1 through 10",other,"not separately reimbursment",,,,1162.02,1015.02,9105.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.41,461.41,
"LESION REMOVAL COLONOSCOPY",P960000286,CDM,960,RC,45385,HCPCS,Outpatient,,,824,412,,,,,,,,0,other,"not separately reimbursement",,,,4463.48,4463.48,4463.48,"1 through 10",other,"not separately reimbursement",482.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,395.52,271.78,395.52,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1162.02,1162.02,1162.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,200.30,197.83,1185.73,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,407.18,241.60,572.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,610.68,150.63,1070.73,"1 through 10",other,"not separately reimbursment",,,,1038.56,681.82,3423.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",482.82,482.82,
"REPAIR FISTULA W/COLOSTOMY",P960000287,CDM,960,RC,45805,HCPCS,Outpatient,,,2845,1422.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1608.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1608.12,1608.12,
"INCISION OF RECTAL ABSCESS",P960000288,CDM,960,RC,46040,HCPCS,Outpatient,,,1040,520,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",593.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,542.80,542.80,542.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,929.61,929.61,929.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",593.82,593.82,
"INCISION OF ANAL ABSCESS",P960000289,CDM,960,RC,46050,HCPCS,Outpatient,,,388,194,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",236.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.84,236.84,
"INCISION OF ANAL SPHINCTER",P960000290,CDM,960,RC,46080,HCPCS,Outpatient,,,482,241,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",292.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",292.4,292.4,
"REMOVAL OF ANAL FISSURE",P960000291,CDM,960,RC,46200,HCPCS,Outpatient,,,863,431.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",501.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,338.86,338.86,338.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.77,78.77,78.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",501.63,501.63,
"LIGATION OF HEMORRHOID(S)",P960000292,CDM,960,RC,46221,HCPCS,Outpatient,,,520,260,,,,,,,,0,other,"not separately reimbursement",,,,184.11,184.11,184.11,"1 through 10",other,"not separately reimbursement",297.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,144.34,144.34,144.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",297.79,297.79,
"HEMORRHOIDECTOMY EXTERNAL",P960000293,CDM,960,RC,46250,HCPCS,Outpatient,,,897,448.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",515.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,299.50,299.50,299.50,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",515.25,515.25,
"HEMORRHOIDECTOMY 2 OR MORE",P960000294,CDM,960,RC,46260,HCPCS,Outpatient,,,937,468.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",524.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,733.16,733.16,733.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2222.52,2112.76,2332.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",524.91,524.91,
"REMOVAL OF HEMORRHOID CLOT",P960000295,CDM,960,RC,46320,HCPCS,Outpatient,,,356,178,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",213.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",213.97,213.97,
"EXCISION OF ANAL LESION(S)",P960000296,CDM,960,RC,46922,HCPCS,Outpatient,,,515,257.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",317.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",317.31,317.31,
"HEMORRHOIDOPEXY BY STAPLING",P960000297,CDM,960,RC,46947,HCPCS,Outpatient,,,753,376.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",420.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",420.97,420.97,
"NEEDLE BIOPSY, LIVER ADD-ON",P960000298,CDM,960,RC,47001,HCPCS,Outpatient,,,208,104,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",114.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.1,114.1,
"LAPAROSCOPIC CHOLECYSTECTOMY",P960000299,CDM,960,RC,47562,HCPCS,Outpatient,,,1301,650.5,,,,,,,,0,other,"not separately reimbursement",,,,845.67,845.67,845.67,"1 through 10",other,"not separately reimbursement",721.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,839.25,291.96,1003.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,618.26,618.26,618.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4599.96,321.21,5314.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,559.10,532.47,2543.45,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1173.47,1173.47,1173.47,"1 through 10",other,"not separately reimbursment",,,,10868.31,10868.31,10868.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",721.23,721.23,
"REMOVAL OF GALLBLADDER",P960000300,CDM,960,RC,47600,HCPCS,Outpatient,,,2114,1057,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1171.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1166.63,1166.63,1166.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1171.77,1171.77,
"EXPLORATION OF ABDOMEN",P960000301,CDM,960,RC,49000,HCPCS,Outpatient,,,1526,763,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",842.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",842.69,842.69,
"ABD PARACENTESIS",P960000302,CDM,960,RC,49082,HCPCS,Outpatient,,,370,185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",220.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.58,220.58,
"ABD PARACENTESIS W/IMAGING",P960000303,CDM,960,RC,49083,HCPCS,Outpatient,,,566,283,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",325.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,532.00,532.00,532.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,739.19,739.19,739.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,809.41,526.31,1092.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1900.81,1900.81,1900.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",325.65,325.65,
"DIAG LAPARO SEPARATE PROC",P960000304,CDM,960,RC,49320,HCPCS,Outpatient,,,645,322.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",359.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",359.47,359.47,
"PRP I/HERN INIT REDUC>5 YR",P960000305,CDM,960,RC,49505,HCPCS,Outpatient,,,1027,513.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",570.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,573.10,573.10,573.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3086.01,3086.01,3086.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2782.40,874.45,4311.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3548.99,3548.99,3548.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",570.36,570.36,
"PRP I/HERN INIT BLOCK>5 YR",P960000306,CDM,960,RC,49507,HCPCS,Outpatient,,,1156,578,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",641.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3510.49,3479.69,3541.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",641.63,641.63,
"REREPAIR ING HERNIA, REDUCE",P960000307,CDM,960,RC,49520,HCPCS,Outpatient,,,1249,624.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",691.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",691.7,691.7,
"REPAIR ING HERNIA, SLIDING",P960000308,CDM,960,RC,49525,HCPCS,Outpatient,,,1132,566,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",628.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",628.11,628.11,
"RPR REM HERNIA, INIT, REDUCE",P960000309,CDM,960,RC,49550,HCPCS,Outpatient,,,1137,568.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",630.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",630.88,630.88,
"RPR FEM HERNIA, INIT BLOCKED",P960000310,CDM,960,RC,49553,HCPCS,Outpatient,,,1246,623,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",691.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",691.01,691.01,
"FRAGMENTING OF KIDNEY STONE",P960000321,CDM,960,RC,50590,HCPCS,Outpatient,,,1417,708.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",615.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",615.75,615.75,
"INJECTION FOR URETER X-RAY",P960000322,CDM,960,RC,50690,HCPCS,Outpatient,,,193,96.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",89.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.88,89.88,
"INCISE & DRAIN BLADDER",P960000323,CDM,960,RC,51040,HCPCS,Outpatient,,,575,287.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",243.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.02,243.02,
"INJECTION FOR BLADDER X-RAY",P960000324,CDM,960,RC,51600,HCPCS,Outpatient,,,352,176,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",169.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.82,169.82,
"IRRIGATION OF BLADDER",P960000325,CDM,960,RC,51700,HCPCS,Outpatient,,,141,70.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",61.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,191.75,191.75,191.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.93,48.93,48.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.81,61.81,
"INSERT BLADDER CATHETER",P960000326,CDM,960,RC,51701,HCPCS,Outpatient,,,92,46,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,32.99,32.99,32.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,313.25,261.76,762.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,298.71,298.71,298.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.99,36.99,
"INSERT TEMP BLADDER CATH",P960000327,CDM,960,RC,51702,HCPCS,Outpatient,,,121,60.5,,,,,,,,0,other,"not separately reimbursement",,,,290.70,290.70,290.70,"1 through 10",other,"not separately reimbursement",50.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,169.10,139.54,515.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,276.32,276.32,276.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.38,50.38,
"INSERT BLADDER CATH, COMPLEX",P960000328,CDM,960,RC,51703,HCPCS,Outpatient,,,244,122,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",115.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,123.34,123.34,123.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,31.48,31.48,31.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.42,115.42,
"CHANGE OF BLADDER TUBE SIMPLE",P960000329,CDM,960,RC,51705,HCPCS,Outpatient,,,176,88,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",78.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.53,78.53,
"CHANGE OF BLADDER TUBE COMP",P960000330,CDM,960,RC,51710,HCPCS,Outpatient,,,250,125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",109.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,526.25,526.25,526.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",109.43,109.43,
"ELECTROUROFLOWMETRY FIRST",P960000331,CDM,960,RC,51741,HCPCS,Outpatient,,,17,8.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.83,11.83,
"US URINE CAPACITY MEASURE",P960000332,CDM,960,RC,51798,HCPCS,Outpatient,,,37,18.5,,,,,,,,0,other,"not separately reimbursement",,,,108.68,108.68,108.68,"1 through 10",other,"not separately reimbursement",8.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.26,8.26,
"REPAIR OF BLADDER WOUND",P960000333,CDM,960,RC,51860,HCPCS,Outpatient,,,1484,742,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",625.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",625.54,625.54,
CYSTOSCOPY,P960000334,CDM,960,RC,52000,HCPCS,Outpatient,,,318,159,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",173.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",173.33,173.33,
"CYSTOSCOPY, REMOVAL OF CLOTS",P960000335,CDM,960,RC,52001,HCPCS,Outpatient,,,733,366.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",345.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",345.87,345.87,
"CYSTOSCOPY & URETER CATHETER",P960000336,CDM,960,RC,52005,HCPCS,Outpatient,,,515,257.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",242.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",242.43,242.43,
"CYSTOSCOPY WITH BIOPSY",P960000337,CDM,960,RC,52204,HCPCS,Outpatient,,,711,355.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",317.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",317.32,317.32,
"CYSTO/TREAT TRIG,NECK,PROFO,UR",P960000338,CDM,960,RC,52214,HCPCS,Outpatient,,,1266,633,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",600.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",600.92,600.92,
"CYSTO/TREAT W ORW/OUT BIO<0.5",P960000339,CDM,960,RC,52224,HCPCS,Outpatient,,,1328,664,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",628.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",628.09,628.09,
"CYSTO AND TREAT 0.5-2.0",P960000340,CDM,960,RC,52234,HCPCS,Outpatient,,,495,247.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",206.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",206.92,206.92,
"CYSTO AND TREAT 2.0-5.0",P960000341,CDM,960,RC,52235,HCPCS,Outpatient,,,580,290,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",242.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",242.91,242.91,
"CYSTO AND TREAT LG TUMOR",P960000342,CDM,960,RC,52240,HCPCS,Outpatient,,,788,394,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",330.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",330.63,330.63,
"CYSTO AND TREAT DIAL BLAD CYST",P960000343,CDM,960,RC,52260,HCPCS,Outpatient,,,422,211,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",177.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.4,177.4,
"CYSTO AND TREAT URETHROTOMY",P960000344,CDM,960,RC,52276,HCPCS,Outpatient,,,532,266,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",222.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",222.73,222.73,
"CYSTO AND TREAT CYSTOGRAPHY",P960000345,CDM,960,RC,52281,HCPCS,Outpatient,,,530,265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",265.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",265.37,265.37,
"CYSTO AND TREAT REM FOR BODY",P960000346,CDM,960,RC,52310,HCPCS,Outpatient,,,475,237.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",239.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",239.58,239.58,
"CYSTO/TREAT REM FOR BODY COMPL",P960000347,CDM,960,RC,52315,HCPCS,Outpatient,,,808,404,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",385.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",385.62,385.62,
"REMOVE BLADDER STONE SIMPLE",P960000348,CDM,960,RC,52317,HCPCS,Outpatient,,,1555,777.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",722.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",722.85,722.85,
"REMOVE BLADDER STONE COMPLX/LG",P960000349,CDM,960,RC,52318,HCPCS,Outpatient,,,952,476,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",399.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",399.44,399.44,
"CYSTO/TREAT URETERAL STENT",P960000350,CDM,960,RC,52332,HCPCS,Outpatient,,,940,470,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",374.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,115.03,115.03,115.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",374.48,374.48,
"CYSTO W/URETER STRICTURE TX",P960000351,CDM,960,RC,52341,HCPCS,Outpatient,,,571,285.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",239.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",239.32,239.32,
"CYSTO/URETERO, STONE REMOVE",P960000352,CDM,960,RC,52344,HCPCS,Outpatient,,,743,371.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",310.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",310.9,310.9,
"CYSTOURETERO & OR PYELOSCOPE",P960000353,CDM,960,RC,52351,HCPCS,Outpatient,,,609,304.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",254.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",254.76,254.76,
"CYSTOURETERO W/LITHOTRIPSY",P960000354,CDM,960,RC,52353,HCPCS,Outpatient,,,788,394,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",330.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",330.63,330.63,
"CYSTOURETERO W/BIOPSY",P960000355,CDM,960,RC,52354,HCPCS,Outpatient,,,839,419.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",351.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",351.76,351.76,
"CYSTO/URETERO W/LITHOTRIPSY",P960000356,CDM,960,RC,52356,HCPCS,Outpatient,,,836,418,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",350.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.4,350.4,
"PROSTATECTOMY (TURP)",P960000357,CDM,960,RC,52601,HCPCS,Outpatient,,,1692,846,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",614.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",614.87,614.87,
"REMOVE PROSTATE REGROWTH",P960000358,CDM,960,RC,52630,HCPCS,Outpatient,,,797,398.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",338.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",338.22,338.22,
"LASER SURGERY OF PROSTATE",P960000359,CDM,960,RC,52648,HCPCS,Outpatient,,,3528,1764,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1384,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1384,1384,
"INCISION OF URETHRA",P960000360,CDM,960,RC,53020,HCPCS,Outpatient,,,195,97.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",81.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.74,81.74,
"TREATMENT OF URETHRA LESION",P960000361,CDM,960,RC,53265,HCPCS,Outpatient,,,430,215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",187.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",187.4,187.4,
"DILATE URETHRA STRICTURE",P960000362,CDM,960,RC,53600,HCPCS,Outpatient,,,164,82,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",70.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.82,70.82,
"DILATION OF URETHRA",P960000363,CDM,960,RC,53660,HCPCS,Outpatient,,,137,68.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.53,58.53,
"DRAIN PENIS LESION",P960000364,CDM,960,RC,54015,HCPCS,Outpatient,,,615,307.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",262.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",262.95,262.95,
"EXCISION OF PENIS LESION(S)",P960000365,CDM,960,RC,54060,HCPCS,Outpatient,,,350,175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",158.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.9,158.9,
"BIOPSY OF PENIS",P960000366,CDM,960,RC,54100,HCPCS,Outpatient,,,385,192.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",167.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",167.97,167.97,
"TREATMENT OF PENIS LESION",P960000367,CDM,960,RC,54115,HCPCS,Outpatient,,,902,451,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.9,388.9,
"CIRCUMCISION CLAMP",P960000368,CDM,960,RC,54150,HCPCS,Outpatient,,,302,151,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",130.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,117.75,115.10,120.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,93.04,91.42,93.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,75.99,75.99,79.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.23,130.23,
"CIRCUMCISION EXCISION",P960000369,CDM,960,RC,54160,HCPCS,Outpatient,,,429,214.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",186.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.48,186.48,
"CIRCUMCISION OLDER 28 DAYS OLD",P960000370,CDM,960,RC,54161,HCPCS,Outpatient,,,392,196,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",169.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.01,169.01,
"LYSIS PENIL CIRCUMIC LESION",P960000371,CDM,960,RC,54162,HCPCS,Outpatient,,,504,252,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",219.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",219.17,219.17,
"EXCISE LESION TESTIS",P960000372,CDM,960,RC,54512,HCPCS,Outpatient,,,1078,539,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",463.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",463.03,463.03,
"REMOVAL OF TESTIS SIMPLE",P960000373,CDM,960,RC,54520,HCPCS,Outpatient,,,649,324.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",279.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",279.33,279.33,
"REMOVAL OF TESTIS RADICAL",P960000374,CDM,960,RC,54530,HCPCS,Outpatient,,,1007,503.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",435.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",435.18,435.18,
"REDUCE TESTIS TORSION",P960000375,CDM,960,RC,54600,HCPCS,Outpatient,,,908,454,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",389.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.1,389.1,
"SUSPENSION OF TESTIS",P960000376,CDM,960,RC,54620,HCPCS,Outpatient,,,599,299.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",257.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",257.29,257.29,
"DRAINAGE OF SCROTUM",P960000377,CDM,960,RC,54700,HCPCS,Outpatient,,,425,212.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",183.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",183.29,183.29,
"REMOVE EPIDIDYMIS LESION",P960000378,CDM,960,RC,54830,HCPCS,Outpatient,,,742,371,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",318.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",318.99,318.99,
"REM LES WORW/OUT EPIDIDYMECTOM",P960000379,CDM,960,RC,54840,HCPCS,Outpatient,,,640,320,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",275.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275.87,275.87,
"REMOVAL OF EPIDIDYMIS",P960000380,CDM,960,RC,54860,HCPCS,Outpatient,,,835,417.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",359.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",359.27,359.27,
"REMOVAL HYDROCELES UNILATERAL",P960000381,CDM,960,RC,55040,HCPCS,Outpatient,,,673,336.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",289.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.04,289.04,
"REMOVAL HYDROCELES BILATERAL",P960000382,CDM,960,RC,55041,HCPCS,Outpatient,,,1017,508.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",438.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",438.68,438.68,
"DRAINAGE OF SCROTUM ABSCESS",P960000383,CDM,960,RC,55100,HCPCS,Outpatient,,,421,210.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",189.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",189.9,189.9,
"REMOVAL OF SPERM DUCT(S)",P960000384,CDM,960,RC,55250,HCPCS,Outpatient,,,555.43,277.715,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",305.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,531.43,531.43,531.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",305.23,305.23,
"BIOPSY OF PROSTATE INCISIONAL",P960000386,CDM,960,RC,55705,HCPCS,Outpatient,,,532,266,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",228.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",228.4,228.4,
"I & D OF VULVA/PERINEUM",P960000387,CDM,960,RC,56405,HCPCS,Outpatient,,,213,106.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",108.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.65,108.65,
"DRAINAGE OF GLAND ABSCESS",P960000388,CDM,960,RC,56420,HCPCS,Outpatient,,,235,117.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",131.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",131.53,131.53,
"SURGERY FOR VULVA LESION",P960000389,CDM,960,RC,56440,HCPCS,Outpatient,,,358,179,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",155.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",155.04,155.04,
"DESTROY, VULVA LESIONS, SIM",P960000390,CDM,960,RC,56501,HCPCS,Outpatient,,,254,127,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",138.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.3,138.3,
"DESTROY VULVA LESION/S COMPL",P960000391,CDM,960,RC,56515,HCPCS,Outpatient,,,442,221,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",213.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",213.95,213.95,
"BIOPSY OF VULVA/PERINEUM",P960000392,CDM,960,RC,56605,HCPCS,Outpatient,,,160,80,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",76.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",76.66,76.66,
"I & D VAGINAL HEMATOMA, PP",P960000393,CDM,960,RC,57022,HCPCS,Outpatient,,,336,168,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",150.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",150.62,150.62,
"REMOVE VAGINA LESION",P960000394,CDM,960,RC,57135,HCPCS,Outpatient,,,375,187.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",188.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.28,188.28,
"TREAT VAGINA INFECTION",P960000395,CDM,960,RC,57150,HCPCS,Outpatient,,,88,44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.29,45.29,
"INSERT PESSARY/OTHER DEVICE",P960000396,CDM,960,RC,57160,HCPCS,Outpatient,,,148,74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.94,57.94,
"FITTING OF DIAPHRAGM/CAP",P960000397,CDM,960,RC,57170,HCPCS,Outpatient,,,119,59.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.73,59.73,
SLING,P960000398,CDM,960,RC,57288,HCPCS,Outpatient,,,1412,706,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",628.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",628.19,628.19,
"EXAM/BIOPSY OF VAG W/SCOPE",P960000399,CDM,960,RC,57421,HCPCS,Outpatient,,,307,153.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",143.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.42,143.42,
"EXAM OF CERVIX W/SCOPE",P960000400,CDM,960,RC,57452,HCPCS,Outpatient,,,213,106.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",101.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,182.27,165.84,198.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",101.78,101.78,
"BX/CURETT OF CERVIX W/SCOPE",P960000401,CDM,960,RC,57454,HCPCS,Outpatient,,,299,149.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,67.73,26.15,109.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.08,139.08,
"BIOPSY OF CERVIX W/SCOPE",P960000402,CDM,960,RC,57455,HCPCS,Outpatient,,,278,139,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",131.07,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,107.49,107.49,107.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,119.15,119.15,119.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",131.07,131.07,
"ENDOCERV CURETTAGE W/SCOPE",P960000403,CDM,960,RC,57456,HCPCS,Outpatient,,,262,131,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,133.66,133.66,133.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,81.25,81.25,81.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.16,123.16,
"BIOPSY OF CERVIX",P960000404,CDM,960,RC,57500,HCPCS,Outpatient,,,246,123,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",121.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",121.05,121.05,
"ENDOCERVICAL CURETTAGE",P960000405,CDM,960,RC,57505,HCPCS,Outpatient,,,198,99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",108.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.79,108.79,
"CONIZATION OF CERVIX",P960000406,CDM,960,RC,57522,HCPCS,Outpatient,,,513,256.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",243.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3197.49,3197.49,3197.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1432.09,1208.32,1432.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.55,243.55,
"BIOPSY OF UTERUS LINING",P960000407,CDM,960,RC,58100,HCPCS,Outpatient,,,213,106.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",82.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,125.88,89.30,162.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,69.09,69.09,69.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.63,82.63,
"DILATION AND CURETTAGE",P960000408,CDM,960,RC,58120,HCPCS,Outpatient,,,563.48,281.74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",238.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1364.25,450.19,2278.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1152.38,1152.38,1152.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.51,238.51,
"MYOMECTOMY ABDOM METHOD",P960000409,CDM,960,RC,58140,HCPCS,Outpatient,,,1807,903.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",795.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",795.08,795.08,
"TOTAL HYSTERECTOMY",P960000410,CDM,960,RC,58150,HCPCS,Outpatient,,,2000,1000,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",864.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,805.91,302.95,870.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,968.19,968.19,968.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",864.82,864.82,
"PARTIAL HYSTERECTOMY",P960000411,CDM,960,RC,58180,HCPCS,Outpatient,,,1894,947,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",823.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",823.33,823.33,
"INSERT INTRAUTERINE DEVICE",P960000412,CDM,960,RC,58300,HCPCS,Outpatient,,,266,133,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",77.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,176.26,97.42,176.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,110.18,110.18,110.18,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.23,77.23,
"REMOVE INTRAUTERINE DEVICE",P960000413,CDM,960,RC,58301,HCPCS,Outpatient,,,185,92.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",85.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,176.26,91.17,176.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,107.00,107.00,107.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",85.95,85.95,
"LAPARO-ASST VAG HYSTERECTOMY",P960000414,CDM,960,RC,58550,HCPCS,Outpatient,,,1732,866,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",756.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",756.76,756.76,
"HYSTEROSCOPY, DX, SEP PROC",P960000415,CDM,960,RC,58555,HCPCS,Outpatient,,,518,259,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",272.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",272.71,272.71,
"HYSTEROSCOPY, BIOPSY",P960000416,CDM,960,RC,58558,HCPCS,Outpatient,,,2585,1292.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1163.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,365.79,365.79,365.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3197.49,3197.49,3197.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1163.94,1163.94,
"HYSTEROSCOPY, ABLATION",P960000417,CDM,960,RC,58563,HCPCS,Outpatient,,,3017,1508.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1633.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4343.79,3847.36,4840.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1633.57,1633.57,
"HYSTEROSCOPY, STERILIZATION",P960000418,CDM,960,RC,58565,HCPCS,Outpatient,,,3574,1787,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1518.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1518.15,1518.15,
"TLH W/T/O 250 G OR LESS",P960000419,CDM,960,RC,58571,HCPCS,Outpatient,,,1764,882,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",766.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,793.81,793.81,793.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",766.73,766.73,
"DIVIS FALLOPIAN TUBE ABD/VAG",P960000420,CDM,960,RC,58600,HCPCS,Outpatient,,,712,356,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",315.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.15,315.15,
"DIVI FALLOP TUBE ABD/VAG POSTP",P960000421,CDM,960,RC,58605,HCPCS,Outpatient,,,644,322,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",285.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,509.43,509.43,509.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",285.28,285.28,
"LIGATE OVIDUCT(S) ADD-ON",P960000422,CDM,960,RC,58611,HCPCS,Outpatient,,,152,76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,97.01,97.01,97.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.19,66.19,
"OCCLUDE FALLOPIAN TUBE(S)",P960000423,CDM,960,RC,58615,HCPCS,Outpatient,,,487,243.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",213.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",213.96,213.96,
"LAPAROSCOPY, REMOVE ADNEXA",P960000424,CDM,960,RC,58661,HCPCS,Outpatient,,,1279,639.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",557.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2543.45,2543.45,2543.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",557.68,557.68,
"LAPAROSCOPY, EXCISE LESIONS",P960000425,CDM,960,RC,58662,HCPCS,Outpatient,,,1397,698.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",609.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,906.78,906.78,906.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",609.65,609.65,
"LAPAROSCOPY, TUBAL BLOCK",P960000426,CDM,960,RC,58671,HCPCS,Outpatient,,,712,356,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",315.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.44,315.44,
"REMOVAL OF OVARY/TUBE(S)",P960000427,CDM,960,RC,58720,HCPCS,Outpatient,,,1450,725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",636.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",636.92,636.92,
"REMOVAL OF OVARIAN CYST(S)",P960000428,CDM,960,RC,58925,HCPCS,Outpatient,,,1467,733.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",648.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",648.04,648.04,
"REMOVAL OF OVARY(S)",P960000429,CDM,960,RC,58940,HCPCS,Outpatient,,,1032,516,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",460.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.98,460.98,
"FETAL NON-STRESS TEST",P960000430,CDM,960,RC,59025,HCPCS,Outpatient,,,94,47,,,,,,,,0,other,"not separately reimbursement",,,,81.32,81.32,81.32,"1 through 10",other,"not separately reimbursement",31.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.75,9.75,9.75,14,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,213.66,174.57,306.79,63,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,376.64,376.64,376.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.77,31.77,
"TREAT ECTOPIC PREGNANCY",P960000431,CDM,960,RC,59151,HCPCS,Outpatient,,,1477,738.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",511.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",511.79,511.79,
"D & C AFTER DELIVERY",P960000432,CDM,960,RC,59160,HCPCS,Outpatient,,,398,199,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",159.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",159.75,159.75,
"EPISIOTOMY OR VAGINAL REPAIR",P960000433,CDM,960,RC,59300,HCPCS,Outpatient,,,376,188,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",142.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.03,142.03,
"REVISION OF CERVIX",P960000434,CDM,960,RC,59320,HCPCS,Outpatient,,,303,151.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",100.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.85,100.85,
"OBSTETRICAL CARE INCL ANTE CAR",P960000435,CDM,960,RC,59400,HCPCS,Outpatient,,,4117,2058.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"OBSTETRICAL CARE DELIVERY ONLY",P960000436,CDM,960,RC,59409,HCPCS,Outpatient,,,3228,1614,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",542.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1017.64,929.71,1237.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,962.01,962.01,962.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,587.99,587.99,618.94,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",542.9,542.9,
"DELIVER PLACENTA",P960000437,CDM,960,RC,59414,HCPCS,Outpatient,,,215.03,107.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",61.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,71.81,71.81,71.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.14,61.14,
"ANTEPARTUM CARE ONLY 4-6 VISIT",P960000438,CDM,960,RC,59425,HCPCS,Outpatient,,,892,446,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",312.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,551.29,503.66,620.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,117.14,117.14,117.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",312.38,312.38,
"ANTEPARTUM CARE ONLY 7+VISITS",P960000439,CDM,960,RC,59426,HCPCS,Outpatient,,,1597,798.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",556.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,957.23,861.51,1001.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",556.39,556.39,
"CARE AFTER DELIVERY",P960000440,CDM,960,RC,59430,HCPCS,Outpatient,,,362,181,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",137.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,325.80,252.91,340.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,246.91,246.91,252.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.02,92.44,100.47,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,170.46,170.46,170.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.81,137.81,
"CESAREAN DELIVERY",P960000441,CDM,960,RC,59510,HCPCS,Outpatient,,,6263.33,3131.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"CESAREAN DELIVERY ONLY",P960000442,CDM,960,RC,59514,HCPCS,Outpatient,,,1820,910,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",611.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1080.26,706.48,1422.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1126.33,1126.33,1126.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,696.29,678.43,749.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,321.23,321.23,321.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",611.82,611.82,
"TREATMENT OF MISCARRIAGE",P960000443,CDM,960,RC,59812,HCPCS,Outpatient,,,624,312,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",227.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,272.75,230.40,315.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3197.49,3197.49,3197.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1432.09,478.04,1432.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",227.93,227.93,
"CARE OF MISCARRIAGE",P960000444,CDM,960,RC,59820,HCPCS,Outpatient,,,742,371,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",273.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1432.09,1432.09,1432.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",273.6,273.6,
"TREAT UTERUS INFECTION",P960000445,CDM,960,RC,59830,HCPCS,Outpatient,,,861,430.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",302.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",302.06,302.06,
"REMOVE CERCLAGE SUTURE",P960000446,CDM,960,RC,59871,HCPCS,Outpatient,,,266,133,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",88.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.59,88.59,
"REMOVE THYROID DUCT LESION",P960000447,CDM,960,RC,60280,HCPCS,Outpatient,,,869,434.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",373.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",373.31,373.31,
"LUMBAR PUNCTURE",P960000448,CDM,960,RC,62270,HCPCS,Outpatient,,,306,153,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,88.88,88.88,88.88,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,224.50,134.93,314.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.22,117.22,
"NJX INTERLAMINAR LMBR/SAC",P960000449,CDM,960,RC,62322,HCPCS,Outpatient,,,302,151,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",126.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",126.63,126.63,
"N BLOCK INJ,  PLANTAR DIGIT",P960000450,CDM,960,RC,64455,HCPCS,Outpatient,,,94,47,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,4.28,4.28,4.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,45.92,45.92,45.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.24,41.24,
"CARPAL TUNNEL SURGERY",P960000451,CDM,960,RC,64721,HCPCS,Outpatient,,,837,418.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",368.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1539.61,1539.61,1774.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,392.77,392.77,392.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",368.45,368.45,
"REMOVE LIMB NERVE LESION",P960000452,CDM,960,RC,64782,HCPCS,Outpatient,,,899,449.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",389.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",389.18,389.18,
"FOREIGN BODY/EAR",P960000453,CDM,960,RC,69200,HCPCS,Outpatient,,,160,80,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",74.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,39.44,39.44,39.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,236.60,138.38,353.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.92,74.92,
"REMOVE IMPACTED EAR WAX UNI",P960000454,CDM,960,RC,69209,HCPCS,Outpatient,,,37.75,18.875,,,,,,,,0,other,"not separately reimbursement",,,,103.68,103.68,103.68,"1 through 10",other,"not separately reimbursement",12.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,10.76,3.57,23.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,14.07,14.07,14.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.57,9.57,9.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,209.13,136.75,331.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,266.75,266.75,266.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.81,12.81,
"REM IMPACTED CERUMEN",P960000455,CDM,960,RC,69210,HCPCS,Outpatient,,,95,47.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,62.33,60.93,63.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,30.05,30.05,30.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,176.09,133.19,218.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.17,44.17,
"MRI NECK SPINE WO DYE",P960000456,CDM,960,RC,72141,HCPCS,Outpatient,,,148,74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",148,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,226.97,190.57,458.50,47,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,544.13,360.50,727.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,243.09,243.09,543.32,"1 through 10",other,"not separately reimbursment",,,,1473.58,229.89,3179.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148,148,
"ARTERY XRAYS ARMSLEGS",P960000457,CDM,960,RC,75716,HCPCS,Outpatient,,,127,63.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.5,117.5,
"US EXAM OF HEAD AND NECK",P960000458,CDM,960,RC,76536,HCPCS,Outpatient,,,223,111.5,,,,,,,,0,other,"not separately reimbursement",,,,106.94,90.96,602.62,"1 through 10",other,"not separately reimbursement",77.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.84,83.84,106.94,56,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,168.95,135.44,347.13,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,106.94,106.94,106.94,"1 through 10",other,"not separately reimbursment",,,,104.81,93.48,431.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.43,77.43,
"ECHO GUIDE FOR BIOPSY",P960000459,CDM,960,RC,76942,HCPCS,Outpatient,,,66,33,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,30.36,24.96,306.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.74,38.74,
"HT MUSCLE IMAGE SPECT SING",P960000460,CDM,960,RC,78451,HCPCS,Outpatient,,,668,334,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",227.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",227.78,227.78,
"HT MUSCLE IMAGE SPECT MULT",P960000461,CDM,960,RC,78452,HCPCS,Outpatient,,,157,78.5,,,,,,,,0,other,"not separately reimbursement",,,,47.33,47.33,47.33,"1 through 10",other,"not separately reimbursement",157,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,59.14,14.21,73.92,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,69.61,69.61,69.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1029.27,55.07,1029.27,93,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,59.88,4.81,2194.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1312.85,1207.82,1312.85,"1 through 10",other,"not separately reimbursment",,,,1286.60,1222.27,3474.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",157,157,
"GATED HEART PLANAR SINGLE",P960000462,CDM,960,RC,78472,HCPCS,Outpatient,,,96,48,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,404.10,404.10,404.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96,96,
"ISTAT METABOLIC PANEL ION CA",P960000463,CDM,960,RC,80047,HCPCS,Outpatient,,,166.48,83.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.87,8.87,
"URINALYSIS, AUTO, W/O SCOPE",P960000464,CDM,960,RC,81003,HCPCS,Outpatient,,,36.75,18.375,QW,,,,,,,0,other,"not separately reimbursement",,,,1.71,1.71,1.71,"1 through 10",other,"not separately reimbursement",1.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1.22,1.08,1.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2.20,2.20,2.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2.20,2.20,2.44,38,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1.89,1.89,1.89,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1.47,1.34,2.06,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.45,1.45,
"URINE PREGNANCY TEST",P960000465,CDM,960,RC,81025,HCPCS,Outpatient,,,25,12.5,QW,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,6.03,4.88,6.03,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,8.44,7.28,9.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7.23,7.23,7.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.14,4.14,4.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.56,5.56,
"ASSAY TEST FOR BLOOD FECAL",P960000466,CDM,960,RC,82274,HCPCS,Outpatient,,,44,22,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.29,10.29,
"REAGENT STRIP/BLOOD GLUCOSE",P960000467,CDM,960,RC,82948,HCPCS,Outpatient,,,15,7.5,QW,,,,,,,0,other,"not separately reimbursement",,,,4.94,4.94,4.94,"1 through 10",other,"not separately reimbursement",3.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,3.53,2.85,3.53,"1 through 10",other,"not separately reimbursment",,,,4.69,4.69,4.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.94,4.94,4.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.23,4.23,4.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.26,3.26,
HEMOGLOBIN,P960000468,CDM,960,RC,85018,HCPCS,Outpatient,,,55.65,27.825,,,,,,,,0,other,"not separately reimbursement",,,,47.12,47.12,47.12,"1 through 10",other,"not separately reimbursement",1.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1.66,1.66,1.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2.32,2.32,2.57,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.16,3.25,4.16,86,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,54.56,54.56,54.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.53,1.53,
"PROTHROMBIN TIME",P960000469,CDM,960,RC,85610,HCPCS,Outpatient,,,11,5.5,,,,,,,,0,other,"not separately reimbursement",,,,44.84,35.87,44.84,"1 through 10",other,"not separately reimbursement",2.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.48,42.48,42.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.20,4.20,4.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.20,4.20,4.64,54,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7.53,6.06,15.46,125,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.29,4.29,4.29,"1 through 10",other,"not separately reimbursment",,,,41.54,5.87,51.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.77,2.77,
"HETEROPHILE ANTIBODIES",P960000470,CDM,960,RC,86308,HCPCS,Outpatient,,,142.8,71.4,QW,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,3.36,3.00,3.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.09,7.31,9.09,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,111.23,111.23,111.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.35,3.35,
"INFLUENZA ASSAY W/OPTIC",P960000471,CDM,960,RC,87804,HCPCS,Outpatient,,,25,12.5,QW,,,,,,,0,other,"not separately reimbursement",,,,12.58,11.07,75.24,"1 through 10",other,"not separately reimbursement",10.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,16.55,12.75,16.55,28,other,"not separately reimbursment",,,,16.31,16.24,16.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,71.28,71.28,71.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,32.44,16.22,32.44,44,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,29.02,22.67,29.02,621,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.98,14.00,87.12,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.69,10.69,
"STREP A ASSAY W/OPTIC",P960000472,CDM,960,RC,87880,HCPCS,Outpatient,,,50,25,QW,,,,,,,0,other,"not separately reimbursement",,,,12.56,12.56,136.04,11,other,"not separately reimbursement",10.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,11.57,8.91,11.57,75,other,"not separately reimbursment",,,,16.37,16.25,16.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,128.88,128.88,128.88,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,16.20,16.20,16.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,16.20,16.20,17.89,134,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,28.99,22.65,28.99,877,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.80,7.84,133.89,18,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.68,10.68,
"NO CALL NO SHOW",P960000473,CDM,960,RC,,,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50,50,
"TETANUS VACCINE, IM",P960000474,CDM,960,RC,90389,HCPCS,Outpatient,,,128,64,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",128,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",128,128,
"IMADM ANY ROUTE 1ST VAC",P960000475,CDM,960,RC,90460,HCPCS,Outpatient,,,49,24.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.5,8.5,
"INADM ANY ROUTE ADDL VAC/TOX",P960000476,CDM,960,RC,90461,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.25,4.25,
"IMMUNIZATION ADMIN",P960000477,CDM,771,RC,90471,HCPCS,Outpatient,,,49,24.5,,89.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.24,76,,10.00,10.00,10.00,15,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",166.45,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",166.45,286,,15.72,13.36,15.72,129,"fee schedule","286% of BCBS fee schedule",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.45,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",58.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",22.05,45,,17.64,,,0,"percent of total billed charges","45% of total billed charges",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.56,100,,19.25,16.36,19.81,28,"fee schedule","100% of CMS OPPS rate",133.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.61,27,,13.10,13.10,29.81,12,"percent of total billed charges","27% of total billed charges",46.55,95,,37.24,,,0,"percent of total billed charges","95% of total billed charges",53.67,100,,0.01,0.01,2.01,"1 through 10","fee schedule","100% of CMS OPPS rate",,,,30.00,30.00,30.00,27,other,"not separately reimbursment",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",21.61,166.45,
"IMMUNIZATION ADMIN",P960000477,CDM,771,RC,90471,HCPCS,Outpatient,,,49,24.5,,89.46,100,,,,,0,"fee schedule","100% of CMS OPPS rate",37.24,76,,10.00,10.00,10.00,15,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",166.45,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",166.45,286,,15.72,13.36,15.72,129,"fee schedule","286% of BCBS fee schedule",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",166.45,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",58.2,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",22.05,45,,17.64,,,0,"percent of total billed charges","45% of total billed charges",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.56,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.56,100,,19.25,16.36,19.81,28,"fee schedule","100% of CMS OPPS rate",133.65,100,,,,,0,"fee schedule","100% of CMS OPPS rate",21.61,27,,13.10,13.10,29.81,12,"percent of total billed charges","27% of total billed charges",46.55,95,,37.24,,,0,"percent of total billed charges","95% of total billed charges",53.67,100,,0.01,0.01,2.01,"1 through 10","fee schedule","100% of CMS OPPS rate",,,,30.00,30.00,30.00,27,other,"not separately reimbursment",44.1,90,,35.28,,,0,"percent of total billed charges","90% of total billed charges",21.61,166.45,
"IMMUNIZATION ADMIN EACH ADD",P960000478,CDM,771,RC,90472,HCPCS,Outpatient,,,25,12.5,,25,125,,,,,0,"fee schedule","125% of CMS fee schedule",19,76,,10.00,10.00,20.00,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.95,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",36.95,286,,7.86,6.68,20.04,81,"fee schedule","286% of BCBS fee schedule",25,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.95,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",12.92,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",11.25,45,,9.00,,,0,"percent of total billed charges","45% of total billed charges",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25,100,,,,,0,"fee schedule","100% CMS fee schedule",25,100,,13.71,11.65,27.58,19,"fee schedule","100% of CMS fee schedule",16.25,65,,13.00,,,0,"percent of total billed charges","65% of total billed charges",11.03,27,,8.82,,,0,"percent of total billed charges","27% of total billed charges",23.75,95,,19.00,,,0,"percent of total billed charges","95% of total billed charges",25,75,,0.01,0.01,0.01,"1 through 10","fee schedule","75% of CMS fee schedule",,,,14.79,14.79,29.58,24,other,"not separately reimbursment",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",11.03,36.95,
"IMMUNIZATION ADMIN EACH ADD",P960000478,CDM,771,RC,90472,HCPCS,Outpatient,,,25,12.5,,25,125,,,,,0,"fee schedule","125% of CMS fee schedule",19,76,,10.00,10.00,20.00,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",36.95,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",36.95,286,,7.86,6.68,20.04,81,"fee schedule","286% of BCBS fee schedule",25,100,,,,,0,"fee schedule","100% of CMS fee schedule",36.95,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",12.92,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",11.25,45,,9.00,,,0,"percent of total billed charges","45% of total billed charges",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",25,100,,,,,0,"fee schedule","100% of CMS fee schedule",25,100,,,,,0,"fee schedule","100% CMS fee schedule",25,100,,13.71,11.65,27.58,19,"fee schedule","100% of CMS fee schedule",16.25,65,,13.00,,,0,"percent of total billed charges","65% of total billed charges",11.03,27,,8.82,,,0,"percent of total billed charges","27% of total billed charges",23.75,95,,19.00,,,0,"percent of total billed charges","95% of total billed charges",25,75,,0.01,0.01,0.01,"1 through 10","fee schedule","75% of CMS fee schedule",,,,14.79,14.79,29.58,24,other,"not separately reimbursment",22.5,90,,18.00,,,0,"percent of total billed charges","90% of total billed charges",11.03,36.95,
"IMMUNE ADMIN ORAL/NASAL",P960000479,CDM,960,RC,90473,HCPCS,Outpatient,,,49,24.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,13.36,13.36,13.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,20.00,20.00,20.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.25,4.25,
"IMMUNE ADMIN ORAL/NASAL ADDL",P960000480,CDM,960,RC,90474,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,5.00,5.00,5.00,"1 through 10",other,"not separately reimbursement",4.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,7.86,7.86,7.86,34,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.26,10.08,11.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,14.79,14.79,14.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4.25,4.25,
"MENB-FHBP VACC 2/3 DOSE IM",P960000481,CDM,960,RC,90621,HCPCS,Outpatient,,,346,173,,,,,,,,0,other,"not separately reimbursement",,,,248.63,248.63,248.63,"1 through 10",other,"not separately reimbursement",160.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,242.56,222.61,242.56,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,201.68,201.68,201.68,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,244.64,243.93,244.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.37,160.37,
"HEP A VACCINE, ADULT IM",P960000482,CDM,960,RC,90632,HCPCS,Outpatient,,,208,104,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.65,73.65,
"HIB VACCINE, PRP-T, IM",P960000484,CDM,960,RC,90648,HCPCS,Outpatient,,,220,110,,,,,,,,0,other,"not separately reimbursement",,,,15.65,15.65,15.65,"1 through 10",other,"not separately reimbursement",11.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,14.98,14.98,14.98,14,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,15.78,6.28,15.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.67,11.67,
"HUMAN PAPILLOMAVIRUS (HPV)",P960000487,CDM,960,RC,90649,HCPCS,Outpatient,,,404,202,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",173.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",173.44,173.44,
"HPV VIRUS VACCINE 9 VAL IM",P960000488,CDM,960,RC,90651,HCPCS,Outpatient,,,436,218,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",243.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,359.90,359.90,359.90,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,337.46,328.35,346.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,330.24,330.24,330.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,362.98,362.98,362.98,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",243.95,243.95,
"FLU VACCINE, 6-35 MO, IM",P960000490,CDM,636,RC,90655,HCPCS,Outpatient,,,66,33,,66,125,,,,,0,"fee schedule","125% of CMS fee schedule",50.16,76,,40.13,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.12,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",43.12,350,,,,,0,"fee schedule","350% of BCBS fee schedule",66,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.12,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",12.32,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",59.4,90,,47.52,,,0,"percent of total billed charges","90% of total billed charges",29.7,45,,23.76,,,0,"percent of total billed charges","45% of total billed charges",59.4,90,,47.52,,,0,"percent of total billed charges","90% of total billed charges",66,100,,,,,0,"fee schedule","100% of CMS fee schedule",66,100,,,,,0,"fee schedule","100% CMS fee schedule",66,100,,,,,0,"fee schedule","100% of CMS fee schedule",42.9,65,,34.32,,,0,"percent of total billed charges","65% of total billed charges",29.11,27,,23.29,,,0,"percent of total billed charges","27% of total billed charges",62.7,95,,50.16,,,0,"percent of total billed charges","95% of total billed charges",66,75,,,,,0,"fee schedule","75% of CMS fee schedule",58.08,88,,46.46,,,0,"percent of total billed charges","88% of total billed charges",59.4,90,,47.52,,,0,"percent of total billed charges","90% of total billed charges",12.32,66,
"FLU VACCINE NO PRESERV 3 AND >",P960000491,CDM,636,RC,90656,HCPCS,Outpatient,,,50,25,,27.94,125,,,,,0,"fee schedule","125% of CMS fee schedule",38,76,,29.03,28.16,29.03,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",43.05,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",43.05,350,,23.08,23.08,24.43,69,"fee schedule","350% of BCBS fee schedule",22.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",43.05,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",12.3,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",45,90,,36.00,,,0,"percent of total billed charges","90% of total billed charges",22.5,45,,18.00,,,0,"percent of total billed charges","45% of total billed charges",45,90,,36.00,,,0,"percent of total billed charges","90% of total billed charges",22.35,100,,23.22,23.22,23.22,"1 through 10","fee schedule","100% of CMS fee schedule",22.35,100,,,,,0,"fee schedule","100% of CMS fee schedule",22.35,100,,22.76,22.68,22.76,"1 through 10","fee schedule","100% of CMS fee schedule",77.2,65,,61.76,,,0,"percent of total billed charges","65% of total billed charges",22.05,27,,21.06,21.06,21.06,"1 through 10","percent of total billed charges","27% of total billed charges",47.5,95,,38.00,,,0,"percent of total billed charges","95% of total billed charges",16.76,75,,23.22,23.22,23.22,"1 through 10","fee schedule","75% of CMS fee schedule",44,88,,24.63,21.18,24.63,12,"percent of total billed charges","88% of total billed charges",45,90,,36.00,,,0,"percent of total billed charges","90% of total billed charges",12.3,77.2,
"INFLUENZA 6-35MS",P960000493,CDM,636,RC,90657,HCPCS,Outpatient,,,56,28,,13.66,125,,,,,0,"fee schedule","125% of CMS fee schedule",42.56,76,,34.05,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",18.73,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",18.73,350,,,,,0,"fee schedule","350% of BCBS fee schedule",10.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",18.73,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",5.35,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",50.4,90,,40.32,,,0,"percent of total billed charges","90% of total billed charges",25.2,45,,20.16,,,0,"percent of total billed charges","45% of total billed charges",50.4,90,,40.32,,,0,"percent of total billed charges","90% of total billed charges",10.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",10.93,100,,,,,0,"fee schedule","100% of CMS fee schedule",58.26,65,,46.61,,,0,"percent of total billed charges","65% of total billed charges",24.7,27,,19.76,,,0,"percent of total billed charges","27% of total billed charges",53.2,95,,42.56,,,0,"percent of total billed charges","95% of total billed charges",8.2,75,,,,,0,"fee schedule","75% of CMS fee schedule",49.28,88,,39.42,,,0,"percent of total billed charges","88% of total billed charges",50.4,90,,40.32,,,0,"percent of total billed charges","90% of total billed charges",5.35,58.26,
"INFLUENZA VACCINE",P960000494,CDM,636,RC,90658,HCPCS,Outpatient,,,72,36,,27.33,125,,,,,0,"fee schedule","125% of CMS fee schedule",54.72,76,,43.78,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",37.42,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",37.42,350,,22.58,22.58,22.58,27,"fee schedule","350% of BCBS fee schedule",21.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.42,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",10.69,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",64.8,90,,51.84,,,0,"percent of total billed charges","90% of total billed charges",32.4,45,,25.92,,,0,"percent of total billed charges","45% of total billed charges",64.8,90,,51.84,,,0,"percent of total billed charges","90% of total billed charges",21.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.86,100,,,,,0,"fee schedule","100% of CMS fee schedule",21.86,100,,21.86,21.86,21.86,"1 through 10","fee schedule","100% of CMS fee schedule",90.52,65,,72.42,,,0,"percent of total billed charges","65% of total billed charges",31.75,27,,25.40,,,0,"percent of total billed charges","27% of total billed charges",68.4,95,,54.72,,,0,"percent of total billed charges","95% of total billed charges",16.4,75,,,,,0,"fee schedule","75% of CMS fee schedule",63.36,88,,23.16,23.16,23.16,"1 through 10","percent of total billed charges","88% of total billed charges",64.8,90,,51.84,,,0,"percent of total billed charges","90% of total billed charges",10.69,90.52,
"INFLUENZA FLUZONE HIGH DOSE+65",P960000498,CDM,636,RC,90662,HCPCS,Outpatient,,,128,64,,104.36,125,,,,,0,"fee schedule","125% of CMS fee schedule",97.28,76,,69.55,69.55,69.55,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",111.93,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",111.93,350,,100.89,71.93,100.89,"1 through 10","fee schedule","350% of BCBS fee schedule",83.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",111.93,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",31.98,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",115.2,90,,92.16,,,0,"percent of total billed charges","90% of total billed charges",57.6,45,,46.08,,,0,"percent of total billed charges","45% of total billed charges",115.2,90,,92.16,,,0,"percent of total billed charges","90% of total billed charges",83.49,100,,86.23,86.23,86.23,"1 through 10","fee schedule","100% of CMS fee schedule",83.49,100,,,,,0,"fee schedule","100% of CMS fee schedule",83.49,100,,96.20,96.20,96.20,98,"fee schedule","100% of CMS fee schedule",250.18,65,,200.14,,,0,"percent of total billed charges","65% of total billed charges",56.45,27,,45.16,,,0,"percent of total billed charges","27% of total billed charges",121.6,95,,97.28,,,0,"percent of total billed charges","95% of total billed charges",62.62,75,,98.16,98.16,98.16,"1 through 10","fee schedule","75% of CMS fee schedule",112.64,88,,98.20,90.15,98.20,"1 through 10","percent of total billed charges","88% of total billed charges",115.2,90,,92.16,,,0,"percent of total billed charges","90% of total billed charges",31.98,250.18,
"PNEUMOCOCCAL VACC 13 VAL IM",P960000500,CDM,636,RC,90670,HCPCS,Outpatient,,,404,202,,404,125,,,,,0,"fee schedule","125% of CMS fee schedule",307.04,76,,271.57,271.57,271.57,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",607.46,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",607.46,350,,,,,0,"fee schedule","350% of BCBS fee schedule",404,100,,,,,0,"fee schedule","100% of CMS fee schedule",607.46,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",173.56,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",363.6,90,,290.88,,,0,"percent of total billed charges","90% of total billed charges",181.8,45,,145.44,,,0,"percent of total billed charges","45% of total billed charges",363.6,90,,290.88,,,0,"percent of total billed charges","90% of total billed charges",404,100,,,,,0,"fee schedule","100% of CMS fee schedule",404,100,,,,,0,"fee schedule","100% CMS fee schedule",404,100,,,,,0,"fee schedule","100% of CMS fee schedule",262.6,65,,210.08,,,0,"percent of total billed charges","65% of total billed charges",178.16,27,,142.53,,,0,"percent of total billed charges","27% of total billed charges",383.8,95,,307.04,,,0,"percent of total billed charges","95% of total billed charges",404,75,,,,,0,"fee schedule","75% of CMS fee schedule",355.52,88,,284.42,,,0,"percent of total billed charges","88% of total billed charges",363.6,90,,290.88,,,0,"percent of total billed charges","90% of total billed charges",173.56,607.46,
ROTAVIRUS,P960000502,CDM,960,RC,90680,HCPCS,Outpatient,,,450,225,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",89.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,115.62,115.62,115.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,116.61,116.61,116.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.51,89.51,
"ROTAVIRUS VACC 2 DOSE ORAL",P960000505,CDM,960,RC,90681,HCPCS,Outpatient,,,450,225,,,,,,,,0,other,"not separately reimbursement",,,,176.27,176.27,176.27,"1 through 10",other,"not separately reimbursement",129.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,162.33,162.33,172.01,34,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,147.07,147.07,154.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,173.48,163.71,173.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",129.45,129.45,
"IIV4 VACCINE SPLT 0.5 ML IM",P960000508,CDM,960,RC,90688,HCPCS,Outpatient,,,60,30,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,39.35,39.35,39.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.15,17.15,
"DTAP-IPV VACC 4-6 YR IM",P960000509,CDM,960,RC,90696,HCPCS,Outpatient,,,162,81,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,73.50,71.46,73.56,35,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,65.54,65.54,66.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,75.17,75.17,75.72,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.24,56.24,
"DTAP-HIB-IP VACCINE, IM",P960000511,CDM,960,RC,90698,HCPCS,Outpatient,,,280,140,,,,,,,,0,other,"not separately reimbursement",,,,143.32,143.32,143.32,"1 through 10",other,"not separately reimbursement",105.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,124.23,124.23,140.47,32,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,121.40,121.40,126.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,141.67,120.47,141.67,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",105.11,105.11,
DTAP,P960000513,CDM,960,RC,90700,HCPCS,Outpatient,,,92,46,,,,,,,,0,other,"not separately reimbursement",,,,35.06,35.06,35.06,"1 through 10",other,"not separately reimbursement",26.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,34.62,33.69,34.62,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,30.80,30.80,31.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,35.39,34.84,35.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.45,26.45,
"DT VACCINE < 7, IM",P960000515,CDM,960,RC,90702,HCPCS,Outpatient,,,140,70,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",60.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.98,60.98,
MMR,P960000517,CDM,960,RC,90707,HCPCS,Outpatient,,,189.46,94.73,,,,,,,,0,other,"not separately reimbursement",,,,113.79,113.79,113.79,"1 through 10",other,"not separately reimbursement",83.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,111.39,110.12,111.39,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,99.48,99.48,100.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,110.74,44.30,113.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",83.77,83.77,
"MMRV VACCINE, SC",P960000519,CDM,960,RC,90710,HCPCS,Outpatient,,,460,230,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",240.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,325.45,325.45,325.45,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,294.85,294.85,294.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,328.23,328.23,328.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.24,240.24,
"POLIOVIRUS, IPV, SC",P960000521,CDM,960,RC,90713,HCPCS,Outpatient,,,116,58,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,52.34,49.89,52.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,52.78,52.78,52.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",37.49,37.49,
"TD VACC NO PRSRV >/= 7 IM",P960000524,CDM,960,RC,90714,HCPCS,Outpatient,,,78,39,,,,,,,,0,other,"not separately reimbursement",,,,110.10,110.10,110.10,"1 through 10",other,"not separately reimbursement",26.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,47.16,47.16,47.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,33.96,28.52,36.37,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,31.87,30.87,67.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.81,58.99,114.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.4,26.4,
"TDAP VACCINE >7 IM VFC/SL",P960000526,CDM,960,RC,90715,HCPCS,Outpatient,,,70,35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,43.53,43.01,51.82,32,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,39.71,38.81,39.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,34.57,34.27,40.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,39.81,39.81,39.81,"1 through 10",other,"not separately reimbursment",,,,57.88,45.01,57.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.05,44.05,
"VARICELLA IMMUNIZATION",P960000527,CDM,960,RC,90716,HCPCS,Outpatient,,,300,150,,,,,,,,0,other,"not separately reimbursement",,,,230.39,221.64,230.39,"1 through 10",other,"not separately reimbursement",145.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,214.11,214.11,214.11,28,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,193.98,193.98,193.98,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,215.94,86.38,215.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.2,145.2,
"TD VACCINE > 7, IM",P960000529,CDM,960,RC,90714,HCPCS,Outpatient,,,122,61,,,,,,,,0,other,"not separately reimbursement",,,,110.10,110.10,110.10,"1 through 10",other,"not separately reimbursement",26.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,47.16,47.16,47.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,33.96,28.52,36.37,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,31.87,30.87,67.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.81,58.99,114.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",26.4,26.4,
"DTAP-HEP B-IPV VACCINE, IM",P960000530,CDM,960,RC,90723,HCPCS,Outpatient,,,230,115,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,122.27,122.27,122.27,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.21,91.21,
"PNEUMO POLYSACCHARIDE",P960000532,CDM,636,RC,90732,HCPCS,Outpatient,,,208,104,,208,125,,,,,0,"fee schedule","125% of CMS fee schedule",158.08,76,,126.46,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",238.07,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",238.07,350,,,,,0,"fee schedule","350% of BCBS fee schedule",208,100,,,,,0,"fee schedule","100% of CMS fee schedule",238.07,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",68.02,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",187.2,90,,149.76,,,0,"percent of total billed charges","90% of total billed charges",93.6,45,,74.88,,,0,"percent of total billed charges","45% of total billed charges",187.2,90,,149.76,,,0,"percent of total billed charges","90% of total billed charges",208,100,,,,,0,"fee schedule","100% of CMS fee schedule",208,100,,,,,0,"fee schedule","100% CMS fee schedule",208,100,,,,,0,"fee schedule","100% of CMS fee schedule",135.2,65,,108.16,,,0,"percent of total billed charges","65% of total billed charges",91.73,27,,73.38,,,0,"percent of total billed charges","27% of total billed charges",197.6,95,,158.08,,,0,"percent of total billed charges","95% of total billed charges",208,75,,,,,0,"fee schedule","75% of CMS fee schedule",183.04,88,,146.43,,,0,"percent of total billed charges","88% of total billed charges",187.2,90,,149.76,,,0,"percent of total billed charges","90% of total billed charges",68.02,238.07,
"MENINGOCOCCAL VACCINE, IM",P960000535,CDM,960,RC,90734,HCPCS,Outpatient,,,346,173,,,,,,,,0,other,"not separately reimbursement",,,,199.95,199.95,199.95,"1 through 10",other,"not separately reimbursement",137.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,161.57,134.10,161.57,38,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,178.14,173.36,179.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,191.22,150.08,196.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",137.33,137.33,
"ZOSTER VACC, SC",P960000536,CDM,960,RC,90736,HCPCS,Outpatient,,,570,285,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",216.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",216.92,216.92,
"HEPB VACC PED/ADOL 3 DOSE IM",P960000538,CDM,636,RC,90744,HCPCS,Outpatient,,,116,58,,116,125,,,,,0,"fee schedule","125% of CMS fee schedule",88.16,76,,70.53,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",68.29,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",68.29,350,,34.22,34.22,34.22,"1 through 10","fee schedule","350% of BCBS fee schedule",116,100,,,,,0,"fee schedule","100% of CMS fee schedule",68.29,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",19.51,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",104.4,90,,83.52,,,0,"percent of total billed charges","90% of total billed charges",52.2,45,,41.76,,,0,"percent of total billed charges","45% of total billed charges",104.4,90,,83.52,,,0,"percent of total billed charges","90% of total billed charges",116,100,,,,,0,"fee schedule","100% of CMS fee schedule",116,100,,,,,0,"fee schedule","100% CMS fee schedule",116,100,,,,,0,"fee schedule","100% of CMS fee schedule",75.4,65,,60.32,,,0,"percent of total billed charges","65% of total billed charges",51.16,27,,40.93,,,0,"percent of total billed charges","27% of total billed charges",110.2,95,,88.16,,,0,"percent of total billed charges","95% of total billed charges",116,75,,,,,0,"fee schedule","75% of CMS fee schedule",102.08,88,,33.72,33.34,33.72,"1 through 10","percent of total billed charges","88% of total billed charges",104.4,90,,83.52,,,0,"percent of total billed charges","90% of total billed charges",19.51,116,
"HEP B VACCINE, ADULT, IM",P960000539,CDM,960,RC,90746,HCPCS,Outpatient,,,240,120,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",62.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,81.30,81.30,83.88,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.31,62.31,
SHINGRIX,P960000540,CDM,960,RC,90750,HCPCS,Outpatient,,,242,121,,,,,,,,0,other,"not separately reimbursement",,,,242.00,242.00,242.00,"1 through 10",other,"not separately reimbursement",165.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,194.41,163.30,194.41,18,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.25,165.25,
"PSYCH DIAGNOSTIC EVALUATION",P960000541,CDM,960,RC,90791,HCPCS,Outpatient,,,260,130,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",143.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.41,143.41,
"PSYCH DIAG EVAL W/MED SRVCS",P960000542,CDM,960,RC,90792,HCPCS,Outpatient,,,291,145.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",143.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,236.00,226.12,246.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,144.52,130.53,158.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,122.65,122.65,122.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.41,143.41,
"PSYTX PT&/FAMILY 30 MINUTES",P960000543,CDM,960,RC,90832,HCPCS,Outpatient,,,127,63.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.19,59.19,
"PSYTX PT&/FAM W/E&M 30 MIN",P960000544,CDM,960,RC,90833,HCPCS,Outpatient,,,131,65.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",62.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",62.14,62.14,
"PSYTX PT&/FAMILY 45 MINUTES",P960000545,CDM,960,RC,90834,HCPCS,Outpatient,,,250.75,125.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.05,86.05,
"PSYTX PT&/FAM W/E&M 45 MIN",P960000546,CDM,960,RC,90836,HCPCS,Outpatient,,,166,83,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",95.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.61,95.61,
"PSYTX PT&/FAMILY 60 MINUTES",P960000547,CDM,960,RC,90837,HCPCS,Outpatient,,,369.07,184.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.89,117.89,
"PSYTX PT&/FAM W/E&M 60 MIN",P960000548,CDM,960,RC,90838,HCPCS,Outpatient,,,219,109.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",109.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",109.94,109.94,
"FAMILY PSYTX W/PATIENT",P960000549,CDM,960,RC,90847,HCPCS,Outpatient,,,211,105.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",95.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.73,95.73,
"AUDIOMETRY SCREEN",P960000550,CDM,960,RC,92551,HCPCS,Outpatient,,,100,50,,,,,,,,0,other,"not separately reimbursement",,,,13.44,13.44,13.44,"1 through 10",other,"not separately reimbursement",13.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,9.64,8.19,9.64,30,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,14.36,10.95,14.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.22,13.22,
"PRQ CARD STENT W/ANGIO 1 VSL",P960000551,CDM,960,RC,92928,HCPCS,Outpatient,,,1184,592,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",690.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,769.42,241.04,878.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,427.03,427.03,427.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",690.47,690.47,
"CARDIOVERSION ELECTRIC, EXT",P960000552,CDM,960,RC,92960,HCPCS,Outpatient,,,308,154,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",127.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.92,127.92,
"CARDIOASSIST, EXTERNAL",P960000553,CDM,960,RC,92971,HCPCS,Outpatient,,,201,100.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",81.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.04,81.04,
"ELECTROCARDIOGRAM, COMPLETE",P960000554,CDM,960,RC,93000,HCPCS,Outpatient,,,33,16.5,,,,,,,,0,other,"not separately reimbursement",,,,11.19,8.96,13.28,"1 through 10",other,"not separately reimbursement",13.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,15.88,2.69,22.64,33,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.53,10.53,10.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.42,9.06,10.53,222,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.49,1.07,11.49,53,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2.28,2.28,2.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.5,13.5,
"ELECTROCARDIOGRAM, TRACING",P960000555,CDM,960,RC,93005,HCPCS,Outpatient,,,16,8,,,,,,,,0,other,"not separately reimbursement",,,,226.48,181.18,226.48,14,other,"not separately reimbursement",6.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,7.85,5.81,10.02,20,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,214.56,214.56,214.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,31.55,9.95,53.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,46.83,5.81,50.70,28,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,6.82,5.33,13.36,192,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,59.74,59.74,115.10,"1 through 10",other,"not separately reimbursment",,,,236.02,196.68,340.91,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.62,6.62,
"CARDIOVASCULAR STRESS TEST",P960000556,CDM,960,RC,93018,HCPCS,Outpatient,,,29,14.5,,,,,,,,0,other,"not separately reimbursement",,,,12.13,10.82,13.44,"1 through 10",other,"not separately reimbursement",12.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,15.00,2.67,20.33,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,13.10,13.10,13.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.37,10.37,10.49,81,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.69,0.59,11.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.1,12.1,
"RHYTHM ECG WITH REPORT",P960000557,CDM,960,RC,93040,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.12,10.12,
"ECG MONITOR/REPORT, 24 HRS",P960000558,CDM,960,RC,93224,HCPCS,Outpatient,,,174,87,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",69.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.96,69.96,
"ECG MONITOR/RECORD, 24 HRS",P960000559,CDM,960,RC,93225,HCPCS,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"ECG MONITOR/REVIEW, 24 HRS",P960000560,CDM,960,RC,93227,HCPCS,Outpatient,,,53,26.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.57,21.57,
"ECG/REVIEW, INTERPRET ONLY",P960000561,CDM,960,RC,93272,HCPCS,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.74,20.74,
"PM DEVICE PROGR EVAL,  DUAL",P960000562,CDM,960,RC,93280,HCPCS,Outpatient,,,114,57,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.51,57.51,
"ICD DEVICE PROG EVAL, 1 SNGL",P960000563,CDM,960,RC,93282,HCPCS,Outpatient,,,123,61.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.03,59.03,
"ICD DEVICE PROGR EVAL, DUAL",P960000564,CDM,960,RC,93283,HCPCS,Outpatient,,,159,79.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.85,73.85,
"ICD DEVICE PROGR EVAL, MULT",P960000565,CDM,960,RC,93284,HCPCS,Outpatient,,,177,88.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",79.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",79.87,79.87,
"PM DEVICE EVAL IN PERSON",P960000566,CDM,960,RC,93288,HCPCS,Outpatient,,,73,36.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.29,39.29,
"ICD DEVICE INTERROGATE",P960000567,CDM,960,RC,93289,HCPCS,Outpatient,,,128,64,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.02,53.02,
"ECHO TRANSTHORACIC COMPLETE",P960000568,CDM,960,RC,93303,HCPCS,Outpatient,,,452,226,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",185,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",185,185,
"TTE W/DOPPLER, COMPLETE",P960000569,CDM,960,RC,93306,HCPCS,Outpatient,,,436,218,,,,,,,,0,other,"not separately reimbursement",,,,66.52,53.59,432.29,11,other,"not separately reimbursement",165.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,72.34,12.87,106.03,29,other,"not separately reimbursment",,,,513.35,513.35,513.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,63.04,53.01,383.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,50.43,49.87,514.84,312,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,54.00,3.46,270.65,37,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,551.40,551.40,551.40,44,other,"not separately reimbursment",,,,540.38,449.48,2060.39,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",165.24,165.24,
"ECHO EXAM OF HEART",P960000570,CDM,960,RC,93308,HCPCS,Outpatient,,,238,119,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",78.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,190.57,190.57,243.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.62,48.62,48.62,"1 through 10",other,"not separately reimbursment",,,,237.83,237.83,237.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.41,78.41,
"ECHO TRANSESOPHA NOT W/93355",P960000571,CDM,960,RC,93314,HCPCS,Outpatient,,,454,227,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",187.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",187.89,187.89,
"ECHO TRANSESOPHA INTERP/REPORT",P960000572,CDM,960,RC,93317,HCPCS,Outpatient,,,368,184,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",146.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",146.63,146.63,
"ECHO TRANSTHORACIC",P960000573,CDM,960,RC,93350,HCPCS,Outpatient,,,460,230,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",151.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.23,151.23,
"L HRT ARTERY/VENTRICLE ANGIO",P960000574,CDM,960,RC,93458,HCPCS,Outpatient,,,1924,962,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",848.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,360.81,136.68,417.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,266.42,266.42,266.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,213.14,154.40,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3234.57,3234.57,3234.57,"1 through 10",other,"not separately reimbursment",,,,3169.89,3169.89,3169.89,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",848.65,848.65,
"L HRT ART/GRFT ANGIO",P960000575,CDM,960,RC,93459,HCPCS,Outpatient,,,2133,1066.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",923.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,61.66,61.66,61.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,241.71,241.71,241.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",923.78,923.78,
"R&L HRT ART/VENTRICLE ANGIO",P960000576,CDM,960,RC,93460,HCPCS,Outpatient,,,2299,1149.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1022.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,885.28,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,868.63,868.63,868.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1022.41,1022.41,
"HEART FLOW RESERVE MEASURE",P960000577,CDM,960,RC,93571,HCPCS,Outpatient,,,354,177,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",167.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",167.68,167.68,
"ANTICOAG MGMT PT WARFARIN",P960000578,CDM,960,RC,93793,HCPCS,Outpatient,,,23.68,11.84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,8.40,8.40,8.40,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7.22,7.22,7.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.63,13.63,
"EXTRACRANIAL STUDY",P960000579,CDM,960,RC,93880,HCPCS,Outpatient,,,385,192.5,,,,,,,,0,other,"not separately reimbursement",,,,190.57,190.57,190.57,"1 through 10",other,"not separately reimbursement",228.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,238.03,203.80,238.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,190.57,190.57,190.57,35,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,773.85,474.91,773.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,243.09,243.09,243.09,"1 through 10",other,"not separately reimbursment",,,,232.27,227.51,237.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",228.68,228.68,
"EXTREMITY STUDY",P960000580,CDM,960,RC,93923,HCPCS,Outpatient,,,262,131,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",151.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,234.55,234.55,234.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",151.27,151.27,
"LOWER EXTREMITY STUDY BILATERA",P960000581,CDM,960,RC,93925,HCPCS,Outpatient,,,492,246,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",290.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,189.22,76.74,228.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,190.57,190.57,190.57,20,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,677.12,386.27,773.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,243.09,165.30,243.09,"1 through 10",other,"not separately reimbursment",,,,784.43,337.94,1230.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",290.34,290.34,
"LOWER EXTREMITY STUDY UNILATER",P960000582,CDM,960,RC,93926,HCPCS,Outpatient,,,289,144.5,,,,,,,,0,other,"not separately reimbursement",,,,104.80,104.80,104.80,"1 through 10",other,"not separately reimbursement",153.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,104.80,104.80,104.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.84,79.16,83.84,18,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.15,183.15,183.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,64.17,29.95,98.39,"1 through 10",other,"not separately reimbursment",,,,99.56,99.56,99.56,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.81,153.81,
"UPPER EXTREMITY STUDY",P960000583,CDM,960,RC,93930,HCPCS,Outpatient,,,396,198,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",236.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",236.02,236.02,
"NEB/MDI RX INITIAL",P960000584,CDM,960,RC,94640,HCPCS,Outpatient,,,35,17.5,,,,,,,,0,other,"not separately reimbursement",,,,188.24,188.24,188.24,"1 through 10",other,"not separately reimbursement",20.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,14.24,14.24,14.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,269.73,245.75,293.71,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.70,7.81,15.61,120,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,76.58,28.72,124.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.08,20.08,
"NEB/MDI DEMO",P960000585,CDM,960,RC,94664,HCPCS,Outpatient,,,33,16.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,26.90,26.90,26.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.87,18.87,
"IMMUNOTHERAPY, ONE INJECTION",P960000586,CDM,960,RC,95115,HCPCS,Outpatient,,,17,8.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,13.46,11.56,15.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.25,7.25,
"IMMUNOTHERAPY INJECTIONS",P960000587,CDM,960,RC,95117,HCPCS,Outpatient,,,19,9.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,15.70,13.48,17.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.38,8.38,
"ALLERGY IMMUNOLOGY SERVICES",P960000588,CDM,960,RC,95199,HCPCS,Outpatient,,,34,17,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34,34,
"AUTO NERV FUNC TST CARDIOVAGAL",P960000589,CDM,960,RC,95921,HCPCS,Outpatient,,,165,82.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",99.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",99.72,99.72,
"AUTO NERV FUNC TST SUDOMOTOR",P960000590,CDM,960,RC,95923,HCPCS,Outpatient,,,270,135,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",148.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",148.36,148.36,
"SC THER INFUSION, ADDL HR",P960000591,CDM,960,RC,96370,HCPCS,Outpatient,,,30,15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.66,17.66,
"THER/PROPH/DIAG INJ, SC/IM",P960000592,CDM,960,RC,96372,HCPCS,Outpatient,,,48,24,,,,,,,,0,other,"not separately reimbursement",,,,195.32,15.36,593.77,"1 through 10",other,"not separately reimbursement",16.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,18.65,12.30,22.16,21,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,231.30,231.30,231.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,10.53,10.53,10.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,56.10,9.30,56.10,63,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.23,10.88,11.79,15,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,26.88,16.83,62.63,"1 through 10",other,"not separately reimbursment",,,,180.93,50.11,226.16,21,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.43,16.43,
"THER/PROPH/DIAG INJ, IA",P960000593,CDM,960,RC,96373,HCPCS,Outpatient,,,37,18.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.28,21.28,
"ACTIVE WOUND CARE/20 CM OR <",P960000594,CDM,960,RC,97597,HCPCS,Outpatient,,,144,72,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",111.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,61.49,61.49,61.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,136.27,85.43,187.11,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,358.09,139.20,358.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,439.63,439.63,439.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",111.72,111.72,
"NEG PRESS WOUND TX, < 50 CM",P960000595,CDM,960,RC,97605,HCPCS,Outpatient,,,81,40.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,439.63,439.63,439.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.09,51.09,
"VISUAL ACUITY SCREEN",P960000596,CDM,960,RC,99173,HCPCS,Outpatient,,,12,6,,,,,,,,0,other,"not separately reimbursement",,,,3.44,3.44,3.44,"1 through 10",other,"not separately reimbursement",3.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,4.75,3.24,4.75,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3.05,3.05,3.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3.80,2.90,3.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.12,3.12,
"OFFICE VISIT, NEW PT., LEVEL 2",P960000598,CDM,960,RC,99202,HCPCS,Outpatient,,,177.55,88.775,,,,,,,,0,other,"not separately reimbursement",,,,26.81,26.81,26.81,"1 through 10",other,"not separately reimbursement",52.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,63.98,21.24,69.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,37.63,25.29,49.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,59.44,47.72,67.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.29,41.09,48.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.50,55.70,141.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.9,52.9,
"OFFICE VISIT, NEW PT., LEVEL 3",P960000599,CDM,960,RC,99203,HCPCS,Outpatient,,,272.6,136.3,,,,,,,,0,other,"not separately reimbursement",,,,62.93,40.23,89.12,14,other,"not separately reimbursement",75.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,70.30,21.27,101.17,93,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.05,63.35,82.95,15,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.99,67.45,105.80,371,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.03,51.08,65.25,120,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,27,other,"not separately reimbursment",,,,97.97,68.52,141.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.02,75.02,
"OFFICE VISIT, NEW PT., LEVEL 4",P960000600,CDM,960,RC,99204,HCPCS,Outpatient,,,407.28,203.64,,,,,,,,0,other,"not separately reimbursement",,,,100.33,100.33,100.33,"1 through 10",other,"not separately reimbursement",114.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,128.54,88.73,154.01,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,155.73,126.15,155.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,123.21,68.40,162.76,50,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.47,81.24,111.31,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,192.52,"1 through 10",other,"not separately reimbursment",,,,211.08,152.79,265.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.84,114.84,
"OFFICE VISIT, NEW PT., LEVEL 5",P960000601,CDM,960,RC,99205,HCPCS,Outpatient,,,538.75,269.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",145.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,200.46,192.96,211.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.55,124.55,124.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,121.69,34.45,150.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.70,109.85,118.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.23,145.23,
"OFFICE VISIT, EST PT., LEVEL 1",P960000602,CDM,960,RC,99211,HCPCS,Outpatient,,,39,19.5,,,,,,,,0,other,"not separately reimbursement",,,,8.10,8.10,8.10,"1 through 10",other,"not separately reimbursement",16.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,17.70,4.46,25.14,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,17.24,17.24,21.71,21,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,15.86,15.86,15.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,261.75,261.75,261.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.04,16.04,
"OFFICE VISIT, EST PT., LEVEL 2",P960000603,CDM,960,RC,99212,HCPCS,Outpatient,,,137.63,68.815,,,,,,,,0,other,"not separately reimbursement",,,,34.51,33.33,42.13,"1 through 10",other,"not separately reimbursement",31.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,19.48,7.03,45.03,41,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.79,5.58,46.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.22,31.78,162.76,81,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,22.59,20.78,26.54,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,64.87,152.00,"1 through 10",other,"not separately reimbursment",,,,51.54,38.02,263.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.56,31.56,
"OFFICE VISIT, EST PT., LEVEL 3",P960000604,CDM,960,RC,99213,HCPCS,Outpatient,,,221.63,110.815,,,,,,,,0,other,"not separately reimbursement",,,,50.92,30.92,75.69,53,other,"not separately reimbursement",52.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,45.85,17.39,70.85,189,other,"not separately reimbursment",,,,72.64,23.42,78.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,65.01,33.74,74.46,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.10,54.35,162.76,1044,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.71,31.23,39.90,328,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,105,other,"not separately reimbursment",,,,69.29,37.71,266.75,33,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.28,52.28,
"OFFICE VISIT, EST PT., LEVEL 4",P960000605,CDM,960,RC,99214,HCPCS,Outpatient,,,313.45,156.725,,,,,,,,0,other,"not separately reimbursement",,,,75.23,46.26,131.60,23,other,"not separately reimbursement",75.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,73.73,25.28,103.73,119,other,"not separately reimbursment",,,,101.34,101.34,101.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,88.30,75.53,99.21,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,135.02,81.08,162.76,669,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.68,43.87,56.03,64,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,69,other,"not separately reimbursment",,,,127.59,60.32,266.75,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.99,75.99,
"OFFICE VISIT, EST PT., LEVEL 5",P960000606,CDM,960,RC,99215,HCPCS,Outpatient,,,441.23,220.615,,,,,,,,0,other,"not separately reimbursement",,,,142.35,141.42,144.68,"1 through 10",other,"not separately reimbursement",102.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,113.98,29.05,138.94,34,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.95,106.93,130.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,113.89,97.45,140.65,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,73.40,61.10,97.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",102.18,102.18,
"INTL IP/OBS HOSP-LOW CPLX",P960000611,CDM,960,RC,99221,HCPCS,Outpatient,,,396,198,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",71.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,61.95,61.95,61.95,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.65,71.65,
"INIT HOSP IP/OBS-MOD CPLX",P960000612,CDM,960,RC,99222,HCPCS,Outpatient,,,270,135,,,,,,,,0,other,"not separately reimbursement",,,,99.57,97.15,101.99,"1 through 10",other,"not separately reimbursement",97.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,121.70,24.63,129.57,20,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,120.69,120.69,120.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,96.55,96.55,97.75,72,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,111.70,95.05,111.70,24,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.04,97.04,
"INIT HOSP IP/OBS-HI CPLX",P960000613,CDM,960,RC,99223,HCPCS,Outpatient,,,399,199.5,,,,,,,,0,other,"not separately reimbursement",,,,136.75,136.75,136.75,"1 through 10",other,"not separately reimbursement",142.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,125.72,32.83,172.06,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,128.70,127.41,160.61,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,141.19,80.34,141.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.76,142.76,
"HOSP SUBS IP/OBS-LOW CPLX",P960000617,CDM,960,RC,99231,HCPCS,Outpatient,,,77,38.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,46.32,37.57,51.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.04,48.04,48.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,38.46,38.46,38.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.73,27.73,
"HOSP SUBS IP/OBS CARE-MOD CPLX",P960000618,CDM,960,RC,99232,HCPCS,Outpatient,,,142,71,,,,,,,,0,other,"not separately reimbursement",,,,58.74,58.74,58.74,"1 through 10",other,"not separately reimbursement",51.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,57.34,14.98,78.48,13,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,58.74,58.67,59.48,20,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,45.48,43.21,53.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.09,51.09,
"HOSP SUBS IP/OBS CARE-HI CPLX",P960000619,CDM,960,RC,99233,HCPCS,Outpatient,,,206,103,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,86.27,35.14,111.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,87.66,87.66,87.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,71.89,71.89,71.89,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.61,73.61,
"ADM/DC DAME DAY-LOW CPLX",P960000620,CDM,960,RC,99234,HCPCS,Outpatient,,,263,131.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",94.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.1,94.1,
"ADM/DC SAME DAY-MOD CPLX",P960000621,CDM,960,RC,99235,HCPCS,Outpatient,,,333,166.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"ADM/DC SAME DAY-HI CPLX",P960000622,CDM,960,RC,99236,HCPCS,Outpatient,,,430,215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",153.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.58,153.58,
"HOSP IP/OBS  DISC <30MIN",P960000623,CDM,960,RC,99238,HCPCS,Outpatient,,,143,71.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,66.94,32.70,83.67,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.81,60.51,77.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,64.14,54.58,64.14,25,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,71.37,71.37,71.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.43,51.43,
"HOSP IP/OBS DISC >30MIN",P960000624,CDM,960,RC,99239,HCPCS,Outpatient,,,211,105.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",75.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,85.73,78.35,93.11,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.5,75.5,
"OFFICE CONSULTATION LEVEL 2",P960000626,CDM,960,RC,99242,HCPCS,Outpatient,,,334,167,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.54,56.54,
"OFFICE CONSULTATION LEVEL 3",P960000627,CDM,960,RC,99243,HCPCS,Outpatient,,,458,229,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",77.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.44,77.44,
"OFFICE CONSULTATION LEVEL 4",P960000628,CDM,960,RC,99244,HCPCS,Outpatient,,,678,339,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",116.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",116.15,116.15,
"OFFICE CONSULTATION LEVEL 5",P960000629,CDM,960,RC,99245,HCPCS,Outpatient,,,878,439,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",141.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.61,141.61,
"INITIAL INPAT CONSULT LEVEL 2",P960000631,CDM,960,RC,99252,HCPCS,Outpatient,,,254,127,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",47.58,47.58,
"INITIAL INPAT CONSULT LEVEL 3",P960000632,CDM,960,RC,99253,HCPCS,Outpatient,,,430,215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,94.30,94.30,94.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.39,73.39,
"CRITICAL CARE 1ST HR",P960000634,CDM,960,RC,99291,HCPCS,Outpatient,,,536,268,,,,,,,,0,other,"not separately reimbursement",,,,1770.05,954.75,2637.29,"1 through 10",other,"not separately reimbursement",196.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,830.42,744.18,2167.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3014.10,3014.10,3014.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,721.94,614.85,974.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,664.33,664.33,2087.54,79,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,847.37,688.47,847.37,"1 through 10",other,"not separately reimbursment",,,,829.06,745.60,2025.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.03,196.03,
"CC EACH ADD 30 MIN",P960000635,CDM,960,RC,99292,HCPCS,Outpatient,,,241,120.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,12.88,12.88,12.88,"1 through 10",other,"not separately reimbursment",,,,687.59,687.59,687.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.84,86.84,
"NURSING FAC SUBSEQ",P960000636,CDM,960,RC,99307,HCPCS,Outpatient,,,87,43.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.97,30.97,
"NURSING FAC SUBSEQ FOCUS",P960000637,CDM,960,RC,99308,HCPCS,Outpatient,,,135,67.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",48.64,48.64,
"NURSING FAC SUBSEQ MOD COMP",P960000638,CDM,960,RC,99309,HCPCS,Outpatient,,,179,89.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",64.23,64.23,
"PROL CARE 1ST HR W/O CONTACT",P960000641,CDM,960,RC,99358,HCPCS,Outpatient,,,220,110,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",78.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.87,78.87,
"PREV CARE NEW PT. AGE <1 YR",P960000642,CDM,960,RC,99381,HCPCS,Outpatient,,,410,205,,,,,,,,0,other,"not separately reimbursement",,,,90.96,90.96,90.96,"1 through 10",other,"not separately reimbursement",77.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,123.68,115.67,123.68,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.19,89.01,101.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,320.04,331.24,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,130.97,130.97,130.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.7,77.7,
"PREVENT CARE NEW PT AGE 1-4",P960000643,CDM,960,RC,99382,HCPCS,Outpatient,,,428,214,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",81.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,125.80,109.68,129.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,107.96,98.25,107.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,320.04,331.24,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,136.89,136.89,136.89,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.43,81.43,
"PREVENT CARE NEW PT. AGE 5-11",P960000644,CDM,960,RC,99383,HCPCS,Outpatient,,,444,222,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",84.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,128.00,113.17,134.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,113.44,112.38,114.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,320.04,331.24,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,142.80,142.80,142.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.92,84.92,
"PREVENT CARE NEW PT. AGE 12-17",P960000645,CDM,960,RC,99384,HCPCS,Outpatient,,,502,251,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",96.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,150.86,145.00,150.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,128.81,128.81,128.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,331.24,320.04,331.24,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,161.39,161.39,161.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96.11,96.11,
"PREVENT CARE NEW PT. AGE 18-39",P960000646,CDM,960,RC,99385,HCPCS,Outpatient,,,490,245,,,,,,,,0,other,"not separately reimbursement",,,,108.56,108.56,108.56,"1 through 10",other,"not separately reimbursement",93.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,124.65,118.07,124.65,24,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,122.58,111.55,122.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,85.29,85.29,85.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,155.90,155.90,155.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.13,93.13,
"PREVENT CARE NEW PT. AGE 40-64",P960000647,CDM,960,RC,99386,HCPCS,Outpatient,,,568,284,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",107.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,143.53,130.76,143.53,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,141.34,141.34,141.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.57,86.57,86.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,164.46,164.46,164.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",107.9,107.9,
"PREV CARE NEW PT. AGE 65+",P960000648,CDM,960,RC,99387,HCPCS,Outpatient,,,616,308,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.21,117.21,
"PREV CARE EST. PT. AGE <1 YR",P960000649,CDM,960,RC,99391,HCPCS,Outpatient,,,366,183,,,,,,,,0,other,"not separately reimbursement",,,,82.08,82.08,82.08,"1 through 10",other,"not separately reimbursement",70.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,111.04,103.85,111.04,47,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,92.28,78.44,94.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,320.04,331.24,201,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,117.87,117.87,117.87,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70.2,70.2,
"PREVENT CARE EST. PT. AGE 1-4",P960000650,CDM,960,RC,99392,HCPCS,Outpatient,,,392,196,,,,,,,,0,other,"not separately reimbursement",,,,87.31,87.31,87.31,"1 through 10",other,"not separately reimbursement",74.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,118.70,100.89,118.70,62,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.31,98.31,101.17,13,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,320.04,331.24,409,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,125.91,104.99,125.91,14,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.77,74.77,
"PREVENT CARE EST. PT. AGE 5-11",P960000651,CDM,960,RC,99393,HCPCS,Outpatient,,,390,195,,,,,,,,0,other,"not separately reimbursement",,,,87.03,87.03,87.03,"1 through 10",other,"not separately reimbursement",74.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,118.32,98.05,118.32,61,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,99.59,98.31,100.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,331.24,320.04,331.24,460,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,125.48,125.48,125.48,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",74.53,74.53,
"PREVENT CARE EST PT. AGE 12-17",P960000652,CDM,960,RC,99394,HCPCS,Outpatient,,,428,214,,,,,,,,0,other,"not separately reimbursement",,,,95.33,95.33,95.33,"1 through 10",other,"not separately reimbursement",81.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,129.04,109.68,129.04,48,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,107.53,96.24,107.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,331.24,320.04,331.24,273,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,137.73,137.73,137.73,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.99,81.99,
"PREVENT CARE EST PT. AGE 18-39",P960000653,CDM,960,RC,99395,HCPCS,Outpatient,,,436,218,,,,,,,,0,other,"not separately reimbursement",,,,97.36,97.36,97.36,"1 through 10",other,"not separately reimbursement",84.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,112.29,105.01,122.42,52,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,94.07,94.07,94.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.04,68.10,331.24,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,128.08,128.08,138.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.01,84.01,
"PREV VISIT EST AGE 40-64",P960000654,CDM,960,RC,99396,HCPCS,Outpatient,,,466,233,,,,,,,,0,other,"not separately reimbursement",,,,88.67,88.67,99.63,"1 through 10",other,"not separately reimbursement",89.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,119.12,111.40,130.90,70,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,120.14,120.14,120.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,73.32,70.87,75.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,143.21,125.41,149.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",89.45,89.45,
"PER PM REEVAL EST PAT 65+ YR",P960000655,CDM,960,RC,99397,HCPCS,Outpatient,,,504,252,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",96.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,128.56,120.74,128.56,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",96.11,96.11,
"BEHAV CHNG SMOKING 3-10 MIN",P960000656,CDM,960,RC,99406,HCPCS,Outpatient,,,28,14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,13.86,13.48,14.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.68,10.68,
"PROLONG CLINCL STAFF SVC",P960000657,CDM,960,RC,99415,HCPCS,Outpatient,,,17,8.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.77,6.77,
"PROLONG CLINCL STAFF SVC ADD",P960000658,CDM,960,RC,99416,HCPCS,Outpatient,,,9,4.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.93,2.93,
"INIT NB EM PER DAY, HOSP",P960000659,CDM,960,RC,99460,HCPCS,Outpatient,,,197,98.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",67.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,76.75,76.15,95.93,13,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,85.18,85.18,85.18,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.71,67.71,
"SBSQ NB EM PER DAY, HOSP",P960000660,CDM,960,RC,99462,HCPCS,Outpatient,,,88,44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,42.36,28.64,42.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.15,31.01,41.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.79,29.79,
"SAME DAY NB DISCHARGE",P960000661,CDM,960,RC,99463,HCPCS,Outpatient,,,235,117.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",78.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,56.99,12.39,101.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,116.12,116.12,116.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",78.18,78.18,
"ATTENDANCE AT DELIVERY",P960000662,CDM,960,RC,99464,HCPCS,Outpatient,,,152,76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",52.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,75.27,75.27,75.27,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.14,95.14,95.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.94,52.94,
"NB RESUSCITATION",P960000663,CDM,960,RC,99465,HCPCS,Outpatient,,,301,150.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",103.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,117.08,117.08,140.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,160.12,160.12,160.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.52,103.52,
"NEONATE CRIT CARE, INITIAL",P960000664,CDM,960,RC,99468,HCPCS,Outpatient,,,1952,976,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",651.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",651.36,651.36,
"INIT DAY HOSP NEONATE CARE",P960000665,CDM,960,RC,99477,HCPCS,Outpatient,,,699,349.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",247.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.37,247.37,
"IC, LBW INF < 1500 GM SUBSQ",P960000666,CDM,960,RC,99478,HCPCS,Outpatient,,,277,138.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",97.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97.25,97.25,
"IC LBW INF 1500-2500 G SUBSQ",P960000667,CDM,960,RC,99479,HCPCS,Outpatient,,,247,123.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",88.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.25,88.25,
"IC INF PBW 2501-5000 G SUBSQ",P960000668,CDM,960,RC,99480,HCPCS,Outpatient,,,238,119,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",84.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.76,84.76,
"INDWLL CATH; 2WAY LATEX W/COAT",P960000669,CDM,960,RC,A4338,HCPCS,Outpatient,,,54,27,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.11,12.11,
"INTERMIT URIN CATH; STRAIT TIP",P960000670,CDM,960,RC,A4351,HCPCS,Outpatient,,,8,4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.79,1.79,
"URINARY LEG OR ABDOMEN BAG",P960000671,CDM,960,RC,A4358,HCPCS,Outpatient,,,8,4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.57,5.57,
"PESSARY NON RUBBER ANY TYPE",P960000672,CDM,960,RC,A4562,HCPCS,Outpatient,,,222,111,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.55,50.55,
"SHOLDR SLING ABD RSTRN PREFAB",P960000673,CDM,960,RC,A4566,HCPCS,Outpatient,,,40,20,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.39,18.39,
"ADMN FLU VAC SCHED SAME DAY",P960000674,CDM,771,RC,G0008,HCPCS,Outpatient,,,94,47,,57.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",71.44,76,,8.44,8.44,8.44,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",67.75,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",67.75,286,,14.84,14.84,14.84,"1 through 10","fee schedule","286% of BCBS fee schedule",46.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",67.75,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",23.69,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",84.6,90,,67.68,,,0,"percent of total billed charges","90% of total billed charges",42.3,45,,33.84,,,0,"percent of total billed charges","45% of total billed charges",84.6,90,,67.68,,,0,"percent of total billed charges","90% of total billed charges",46.39,100,,28.91,25.70,32.11,"1 through 10","fee schedule","100% of CMS OPPS rate",46.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.39,100,,32.11,32.11,32.11,106,"fee schedule","100% of CMS OPPS rate",86.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",41.45,27,,33.16,,,0,"percent of total billed charges","27% of total billed charges",89.3,95,,71.44,,,0,"percent of total billed charges","95% of total billed charges",34.78,100,,0.01,0.01,0.01,"1 through 10","fee schedule","100% of CMS OPPS rate",,,,25.70,25.70,26.66,"1 through 10",other,"not separately reimbursment",84.6,90,,67.68,,,0,"percent of total billed charges","90% of total billed charges",23.69,89.3,
"ADMN PNEUMCOC VAC SCHED DAY",P960000675,CDM,771,RC,G0009,HCPCS,Outpatient,,,46,23,,57.99,100,,,,,0,"fee schedule","100% of CMS OPPS rate",34.96,76,,27.97,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",136.51,286,,,,,0,"fee schedule","286% of BCBS DEL RIO fee schedule",136.51,286,,,,,0,"fee schedule","286% of BCBS fee schedule",46.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",136.51,286,,,,,0,"fee schedule","286% of BCBS PPO fee schedule",47.73,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",41.4,90,,33.12,,,0,"percent of total billed charges","90% of total billed charges",20.7,45,,16.56,,,0,"percent of total billed charges","45% of total billed charges",41.4,90,,33.12,,,0,"percent of total billed charges","90% of total billed charges",46.39,100,,25.70,25.70,30.83,"1 through 10","fee schedule","100% of CMS OPPS rate",46.39,100,,,,,0,"fee schedule","100% of CMS OPPS rate",46.39,100,,32.11,32.11,32.11,"1 through 10","fee schedule","100% of CMS OPPS rate",86.64,100,,,,,0,"fee schedule","100% of CMS OPPS rate",20.29,27,,16.23,,,0,"percent of total billed charges","27% of total billed charges",43.7,95,,34.96,,,0,"percent of total billed charges","95% of total billed charges",34.78,100,,,,,0,"fee schedule","100% of CMS OPPS rate",,,,26.50,25.86,27.14,"1 through 10",other,"not separately reimbursment",41.4,90,,33.12,,,0,"percent of total billed charges","90% of total billed charges",20.29,136.51,
"CERV CANCR SCR;PELV BRST EX",P960000676,CDM,960,RC,G0101,HCPCS,Outpatient,,,98.18,49.09,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,203.45,33.13,203.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.98,28.98,
"COLO CANCER SCREENING; FLEXSIG",P960000677,CDM,960,RC,G0104,HCPCS,Outpatient,,,319,159.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",127.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,898.52,898.52,898.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.75,127.75,
"COLO CANCR SCR; COLON HI RISK",P960000678,CDM,960,RC,G0105,HCPCS,Outpatient,,,611,305.5,,,,,,,,0,other,"not separately reimbursement",,,,4463.48,4463.48,4463.48,"1 through 10",other,"not separately reimbursement",242.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,169.70,169.70,169.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,171.81,171.81,898.52,20,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,458.43,458.43,458.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",242.45,242.45,
"DM OP SLF-MGMT TRN SRVC 30 MIN",P960000679,CDM,960,RC,G0108,HCPCS,Outpatient,,,105,52.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",41.34,41.34,
"COLO CNCR SCR;COLNS NO HI RSK",P960000680,CDM,960,RC,G0121,HCPCS,Outpatient,,,612,306,,,,,,,,0,other,"not separately reimbursement",,,,4463.48,4463.48,4463.48,"1 through 10",other,"not separately reimbursement",242.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,173.46,173.46,173.46,"1 through 10",other,"not separately reimbursment",,,,539.60,245.27,833.93,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,169.27,168.69,169.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,458.43,169.99,916.86,40,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,863.96,863.96,863.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,458.43,458.43,916.86,"1 through 10",other,"not separately reimbursment",,,,897.03,538.22,7442.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",242.82,242.82,
"TRIMMING DYSTROPHIC NAILS",P960000681,CDM,960,RC,G0127,HCPCS,Outpatient,,,44,22,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,20.16,20.16,20.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,21.86,21.86,21.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",17.31,17.31,
"EXT COUNTERPULSATION-TX SESS",P960000682,CDM,960,RC,G0166,HCPCS,Outpatient,,,261,130.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.67,73.67,
"MD RECERTIFICATION HHA PT",P960000683,CDM,960,RC,G0179,HCPCS,Outpatient,,,80,40,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,4.61,4.61,4.61,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,26.40,26.40,26.40,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.84,29.84,
"MD CERTIFICATION HHA PATIENT",P960000684,CDM,960,RC,G0180,HCPCS,Outpatient,,,104,52,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.96,38.96,
"ANN WELL VST; PERSNL PPS INIT",P960000685,CDM,960,RC,G0438,HCPCS,Outpatient,,,334,167,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",125.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,266.75,266.75,266.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",125.03,125.03,
"ANN WELL VST; PPS SUBSQT VST",P960000686,CDM,960,RC,G0439,HCPCS,Outpatient,,,226,113,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",84.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,96.34,96.34,113.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,203.45,102.37,203.45,21,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,266.75,266.75,266.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.61,84.61,
"INJECT PCN G BENZ 100000 UNITS",P960000687,CDM,960,RC,,,Outpatient,,,20,10,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"CEFTRIAXONE (ROCEPHIN) IM / IV",P960000688,CDM,960,RC,,,Outpatient,,,10,5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10,10,
"INJ METHYLPRDN ACTAT 40 MG",P960000689,CDM,960,RC,,,Outpatient,,,20,10,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"INJ METHYLPRDN ACTAT 80 MG",P960000690,CDM,960,RC,,,Outpatient,,,44,22,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44,44,
DEPO-PROVERA,P960000691,CDM,960,RC,,,Outpatient,,,120,60,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",120,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120,120,
"DEXAMETH SODIUM PHOSPH 1 MG",P960000692,CDM,960,RC,,,Outpatient,,,5,2.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5,5,
"INJ DIPHENHYDRA HCL UP 50 MG",P960000693,CDM,960,RC,,,Outpatient,,,6,3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6,6,
"INJ KETO TROMETHAMINE 15 MG",P960000694,CDM,960,RC,,,Outpatient,,,20,10,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"LIDO HCI 1% 10 ML MULTI VIAL",P960000695,CDM,960,RC,,,Outpatient,,,20,10,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"PROGESTERONE PER 50 MG",P960000696,CDM,960,RC,,,Outpatient,,,5,2.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5,5,
"INJECT, PROGESTERONE, 50 MG",P960000697,CDM,960,RC,,,Outpatient,,,4,2,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4,4,
"RHOPHYLAC INJECTION",P960000698,CDM,960,RC,,,Outpatient,,,288,144,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",288,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",288,288,
"SOL-MEDROL 125 MG",P960000700,CDM,960,RC,,,Outpatient,,,20,10,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20,20,
"PROMAZINE HCL INJECTION 25 MG",P960000701,CDM,960,RC,,,Outpatient,,,5,2.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5,5,
"INJ TRIAMCIN ACETONIDE 10 MG",P960000702,CDM,960,RC,,,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50,50,
"INJ VIT B12 CYNOCO 1000 MCG",P960000703,CDM,960,RC,,,Outpatient,,,6,3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6,6,
"INTRAUTERINE COPPER CONTRA",P960000704,CDM,960,RC,,,Outpatient,,,1220,610,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1220,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1220,1220,
"ETONOGESTREL IMPLANT SYSTEM",P960000705,CDM,960,RC,,,Outpatient,,,2690,1345,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2690,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2690,2690,
"GEL ONE",P960000706,CDM,960,RC,,,Outpatient,,,3047.5,1523.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3047.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3047.5,3047.5,
"ALBUTEROL INHAL UNIT DOSE 1 MG",P960000707,CDM,960,RC,,,Outpatient,,,4,2,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4,4,
"LEVALBUTEROL INHAL DOSE 0.5 MG",P960000708,CDM,960,RC,,,Outpatient,,,12,6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12,12,
"ALBUTEROL SULFATE .083%/ML",P960000709,CDM,960,RC,,,Outpatient,,,4,2,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",4,4,
"BUDESONIDE INHALATION SOL",P960000710,CDM,960,RC,,,Outpatient,,,22,11,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22,22,
"SCR PAP SMER; PREP&CONVY-LAB",P960000711,CDM,960,RC,,,Outpatient,,,86,43,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86,86,
"FLU VAC 3 YRS & > IM FLUZONE",P960000712,CDM,636,RC,Q2038,HCPCS,Outpatient,,,36,18,,36,125,,,,,0,"fee schedule","125% of CMS fee schedule",27.36,76,,21.89,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",37.42,350,,,,,0,"fee schedule","350% of BCBS DEL RIO fee schedule",37.42,350,,,,,0,"fee schedule","350% of BCBS fee schedule",36,100,,,,,0,"fee schedule","100% of CMS fee schedule",37.42,350,,,,,0,"fee schedule","350% of BCBS PPO fee schedule",10.69,100,,,,,0,"fee schedule","100% of BCBS ADV HMO fee schedule",32.4,90,,25.92,,,0,"percent of total billed charges","90% of total billed charges",16.2,45,,12.96,,,0,"percent of total billed charges","45% of total billed charges",32.4,90,,25.92,,,0,"percent of total billed charges","90% of total billed charges",36,100,,,,,0,"fee schedule","100% of CMS fee schedule",36,100,,,,,0,"fee schedule","100% CMS fee schedule",36,100,,,,,0,"fee schedule","100% of CMS fee schedule",23.4,65,,18.72,,,0,"percent of total billed charges","65% of total billed charges",15.88,27,,12.70,,,0,"percent of total billed charges","27% of total billed charges",34.2,95,,27.36,,,0,"percent of total billed charges","95% of total billed charges",36,75,,,,,0,"fee schedule","75% of CMS fee schedule",31.68,88,,25.34,,,0,"percent of total billed charges","88% of total billed charges",32.4,90,,25.92,,,0,"percent of total billed charges","90% of total billed charges",10.69,37.42,
"TELEHEALTH ORIG SITE FAC FEE",P960000713,CDM,960,RC,Q3014,HCPCS,Outpatient,,,35,17.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.07,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.07,21.07,
"PPD SKIN TEST INJ",P960000716,CDM,960,RC,86580,HCPCS,Outpatient,,,15.44,7.72,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,5.59,5.59,5.59,14,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.68,5.68,
"PPD SKIN TEST INJ",P960000717,CDM,960,RC,86580,HCPCS,Outpatient,,,32,16,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,5.59,5.59,5.59,14,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.68,5.68,
"ADDL 30MIN-W/O CONT",P960000719,CDM,960,RC,99359,HCPCS,Outpatient,,,106,53,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.41,38.41,
"P/M COUNSEL,INDIV 15MIN",P960000720,CDM,960,RC,99401,HCPCS,Outpatient,,,175,87.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,33.20,33.20,33.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.66,27.66,
"P/M COUNSEL,INDIV 30MIN",P960000721,CDM,960,RC,99402,HCPCS,Outpatient,,,257,128.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.88,45.88,
"P/M COUNSEL,INDIV 45MIN",P960000722,CDM,960,RC,99403,HCPCS,Outpatient,,,217.75,108.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63,63,
"P/M COUNSEL,INDIV 60MIN",P960000723,CDM,960,RC,99404,HCPCS,Outpatient,,,257.15,128.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",80.73,80.73,
"BEHAV CHNG SMOKING<10MIN",P960000724,CDM,960,RC,99407,HCPCS,Outpatient,,,55,27.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.36,20.36,
"AUDIT/DAST 15-30 MIN",P960000725,CDM,960,RC,99408,HCPCS,Outpatient,,,164,82,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.45,25.45,
"AUDIT/DAST 15-30 MIN",P960000726,CDM,960,RC,99409,HCPCS,Outpatient,,,144.23,72.115,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.36,49.36,
"INTERPROF PHONE/ONLINE 5-10",P960000730,CDM,960,RC,99446,HCPCS,Outpatient,,,44.55,22.275,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.36,11.36,
"INTERPROF PHONE/ONLINE 11-20",P960000731,CDM,960,RC,99447,HCPCS,Outpatient,,,89.95,44.975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.94,22.94,
"INTERPROF PHONE/ONLINE 21-30",P960000732,CDM,960,RC,99448,HCPCS,Outpatient,,,134.53,67.265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.3,34.3,
"INTERPROF PHONE/ONLINE 31/>",P960000733,CDM,960,RC,99449,HCPCS,Outpatient,,,179.3,89.65,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.72,45.72,
"ACNE SURGERY",P960000734,CDM,960,RC,10040,HCPCS,Outpatient,,,197,98.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",98.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.4,98.4,
"TRIM SKIN LESIONS OVER 4",P960000735,CDM,960,RC,11057,HCPCS,Outpatient,,,126,63,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.19,73.19,
"REMOVE SKIN TAGS ADD-ON",P960000736,CDM,960,RC,11201,HCPCS,Outpatient,,,37,18.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.88,16.88,
"SHAVE S,N,H>2CM",P960000737,CDM,960,RC,11308,HCPCS,Outpatient,,,292,146,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",138.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",138.65,138.65,
"REMOVAL SWEAT GLAND LESION",P960000739,CDM,960,RC,11450,HCPCS,Outpatient,,,733,366.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",365.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",365.83,365.83,
"REMOVAL SWEAT GLAND LESION",P960000740,CDM,960,RC,11451,HCPCS,Outpatient,,,935,467.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",456.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",456.21,456.21,
"REMOVAL SWEAT GLAND LESION",P960000741,CDM,960,RC,11462,HCPCS,Outpatient,,,716,358,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",356.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",356.32,356.32,
"REMOVAL SWEAT GLAND LESION",P960000742,CDM,960,RC,11463,HCPCS,Outpatient,,,948,474,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",463.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",463.97,463.97,
"REMOVAL SWEAT GLAND LESION",P960000743,CDM,960,RC,11470,HCPCS,Outpatient,,,793,396.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.76,388.76,
"REMOVAL SWEAT GLAND LESION",P960000744,CDM,960,RC,11471,HCPCS,Outpatient,,,985,492.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",473.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,475.70,475.70,475.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",473.96,473.96,
"EXC TR-EXT MLG MARG 0.5<CM",P960000745,CDM,960,RC,11600,HCPCS,Outpatient,,,370,185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",177.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.08,177.08,
"HEPATITIS A (PEDIATRICS)",P960000747,CDM,960,RC,90633,HCPCS,Outpatient,,,104,52,,,,,,,,0,other,"not separately reimbursement",,,,46.46,46.46,46.80,"1 through 10",other,"not separately reimbursement",35.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,45.78,44.47,45.78,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.03,40.73,41.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,45.68,40.82,46.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.16,35.16,
"METHYLPREDNISOLONE ACETAT 20MG",P960000748,CDM,960,RC,,,Outpatient,,,14,7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",14,14,
"ADMIN HEP B VAC FEE SCHED DAY",P960000749,CDM,771,RC,,,Outpatient,,,91.48,45.74,,91.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.52,76,,55.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.87,72,,52.70,,,0,"percent of total billed charges","72% of total billed charges",68.61,75,,54.89,,,0,"percent of total billed charges","75% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.87,72,,52.70,,,0,"percent of total billed charges","72% of total billed charges",54.89,60,,43.91,,,0,"percent of total billed charges","60% of total billed charges",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",41.17,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.48,100,,,,,0,"fee schedule","100% CMS fee schedule",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.46,65,,47.57,,,0,"percent of total billed charges","65% of total billed charges",40.34,27,,32.27,,,0,"percent of total billed charges","27% of total billed charges",86.91,95,,69.53,,,0,"percent of total billed charges","95% of total billed charges",91.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",,,,,,,0,other,"not separately reimbursment",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",40.34,91.48,
"ADMIN HEP B VAC FEE SCHED DAY",P960000749,CDM,771,RC,,,Outpatient,,,91.48,45.74,,91.48,125,,,,,0,"fee schedule","125% of CMS fee schedule",69.52,76,,55.62,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",65.87,72,,52.70,,,0,"percent of total billed charges","72% of total billed charges",68.61,75,,54.89,,,0,"percent of total billed charges","75% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",65.87,72,,52.70,,,0,"percent of total billed charges","72% of total billed charges",54.89,60,,43.91,,,0,"percent of total billed charges","60% of total billed charges",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",41.17,45,,32.94,,,0,"percent of total billed charges","45% of total billed charges",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",91.48,100,,,,,0,"fee schedule","100% CMS fee schedule",91.48,100,,,,,0,"fee schedule","100% of CMS fee schedule",59.46,65,,47.57,,,0,"percent of total billed charges","65% of total billed charges",40.34,27,,32.27,,,0,"percent of total billed charges","27% of total billed charges",86.91,95,,69.53,,,0,"percent of total billed charges","95% of total billed charges",91.48,75,,,,,0,"fee schedule","75% of CMS fee schedule",,,,,,,0,other,"not separately reimbursment",82.33,90,,65.86,,,0,"percent of total billed charges","90% of total billed charges",40.34,91.48,
"MENB-4C VACC 2 DOSE IM",P960000750,CDM,960,RC,90620,HCPCS,Outpatient,,,760.67,380.335,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",195.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",195.45,195.45,
"RHO D IMMUNE GLOBULIN INJ",P960000751,CDM,960,RC,,,Outpatient,,,234,117,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",234,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",234,234,
"PROMETHAZINE HCL INJ,UPTO 50MG",P960000752,CDM,960,RC,,,Outpatient,,,6,3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6,6,
"INJ,ONDANSETRON HCL PER 1MG",P960000753,CDM,960,RC,,,Outpatient,,,1.12,0.56,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.12,1.12,
"GLYCOSYLATED HB HOME DEVICE",P960000754,CDM,960,RC,83037,HCPCS,Outpatient,,,24.28,12.14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.27,6.27,
"POST OP FOLLOW UP VISIT",P960000756,CDM,960,RC,99024,HCPCS,Outpatient,,,43.5,21.75,,,,,,,,0,other,"not separately reimbursement",,,,3.39,2.71,3.39,"1 through 10",other,"not separately reimbursement",2.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,5.78,4.04,7.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,162.76,162.76,162.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.88,2.88,
"INFLU FLU PEDS 6-35MO",P960000757,CDM,960,RC,90687,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",8.58,8.58,
"AUTONOMIC FUNCTION TEST VASOM",P960000760,CDM,960,RC,95922,HCPCS,Outpatient,,,193,96.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",114.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.06,114.06,
"ANS PARASYMP & SYMP W/TILT",P960000761,CDM,960,RC,95924,HCPCS,Outpatient,,,179,89.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",174.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",174.73,174.73,
"SURG TX ECT PREG,TUB/OVAR WO",P960000762,CDM,960,RC,59121,HCPCS,Outpatient,,,1567,783.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",541.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.04,541.04,
"PUNCH BX SKIN SINGLE LESION",P960000763,CDM,960,RC,11104,HCPCS,Outpatient,,,307,153.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",112.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,22.85,22.85,22.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,67.85,67.85,67.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,89.55,78.81,90.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,57.12,57.12,57.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.7,112.7,
"REMOVE INT/EXT HEM 1 GROUP",P960000765,CDM,960,RC,46255,HCPCS,Outpatient,,,983,491.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",562.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",562.9,562.9,
"EXC NECK TUM DEEP 5 CM>",P960000766,CDM,960,RC,21554,HCPCS,Outpatient,,,1447,723.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",632.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",632.05,632.05,
"DOPPLER COLOR FLOW",P960000767,CDM,960,RC,93325,HCPCS,Outpatient,,,48,24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",19.64,19.64,
"INCISION THROMBOSED HEMORR EXT",P960000768,CDM,960,RC,46083,HCPCS,Outpatient,,,341,170.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",208.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",208.76,208.76,
"DESTR CUT VASC LES 10SQ CM<",P960000769,CDM,960,RC,17106,HCPCS,Outpatient,,,664.01,332.005,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",308.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",308.03,308.03,
CPR,P960000772,CDM,960,RC,92950,HCPCS,Outpatient,,,591,295.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",258.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,245.52,245.52,245.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,187.90,87.68,288.11,"1 through 10",other,"not separately reimbursment",,,,2814.39,2814.39,2814.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",258.75,258.75,
"DUPLEX EXT VEINS BILAT",P960000773,CDM,960,RC,93970,HCPCS,Outpatient,,,375,187.5,,,,,,,,0,other,"not separately reimbursement",,,,190.57,190.57,190.57,"1 through 10",other,"not separately reimbursement",223.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,238.22,199.02,238.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,190.57,190.57,190.57,51,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,388.40,303.07,773.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,243.09,243.09,243.09,12,other,"not separately reimbursment",,,,226.32,226.32,235.84,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",223.2,223.2,
"ARTHROSC KNEE, FR INF/LAVAGE",P960000774,CDM,960,RC,29871,HCPCS,Outpatient,,,1009,504.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",443.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",443.79,443.79,
"MANIPULATE,HIP JNT W ANEST",P960000776,CDM,960,RC,,,Outpatient,,,449.95,224.975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",449.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",449.95,449.95,
"OP/PERC TX TIB SHAFT FX BY IM",P960000777,CDM,960,RC,27759,HCPCS,Outpatient,,,2463.03,1231.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",864.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",864.38,864.38,
"NEONATE CRIT CARE SUBSQ<=28DAY",P960000778,CDM,960,RC,99469,HCPCS,Outpatient,,,984.73,492.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",282.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",282.06,282.06,
"PUNCH BX SKIN EA SEP/ADDL",P960000779,CDM,960,RC,11105,HCPCS,Outpatient,,,147.8,73.9,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.33,54.33,
"OB US>=14 WKS SNGL FETUS",P960000780,CDM,960,RC,76805,HCPCS,Outpatient,,,124.05,62.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",93.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,776.70,776.70,776.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,106.94,99.85,106.94,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,168.95,134.67,172.38,66,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,569.58,539.20,599.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",93.87,93.87,
"OB US<14 WKS SINGLE FETUS",P960000781,CDM,960,RC,76801,HCPCS,Outpatient,,,124.05,62.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",82.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,106.94,106.23,106.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,135.95,132.39,172.38,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,312.60,312.60,312.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.1,82.1,
"THER SPI PNXR DRG CSF",P960000782,CDM,960,RC,62272,HCPCS,Outpatient,,,217.15,108.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",153.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.2,153.2,
"SURG TX MISSED ABORT:2NDTRIMST",P960000783,CDM,960,RC,59821,HCPCS,Outpatient,,,902.45,451.225,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",272.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",272.43,272.43,
"INPT/ED TELECONSULT 30",P960000784,CDM,960,RC,,,Outpatient,,,247.13,123.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",247.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.13,247.13,
"INPT/ED TELECONSULT50",P960000785,CDM,960,RC,,,Outpatient,,,336.03,168.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",336.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",336.03,336.03,
"INPT/ED TELECONSULT70",P960000786,CDM,960,RC,,,Outpatient,,,497.98,248.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",497.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",497.98,497.98,
"CYSTO W STONE MANIP OR REM",P960000787,CDM,960,RC,52352,HCPCS,Outpatient,,,888.03,444.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",298.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",298.91,298.91,
"UNLISTED OB PROCEDURE",P960000788,CDM,960,RC,59899,HCPCS,Outpatient,,,398.58,199.29,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",332.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",332.35,332.35,
"CHOLEDOCHOTOMY; WO TD SPHINCTE",P960000789,CDM,960,RC,47420,HCPCS,Outpatient,,,3326.02,1663.01,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1470.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.1,1470.1,
"CL TX RADIAL & ULNA FX W MANIP",P960000790,CDM,960,RC,25565,HCPCS,Outpatient,,,1145,572.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",444.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,557.59,557.59,557.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1261.80,1261.80,1261.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",444.96,444.96,
"WINDOWING OF CAST",P960000791,CDM,960,RC,29730,HCPCS,Outpatient,,,107.85,53.925,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.02,53.02,
"OP TX ACLAV DISLOC ACUTE/CHRON",P960000792,CDM,960,RC,23550,HCPCS,Outpatient,,,1414.87,707.435,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",495.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.49,495.49,
"TX HUMERUS SH FX W IMLANT",P960000793,CDM,960,RC,24516,HCPCS,Outpatient,,,2122.3,1061.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",743.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",743.23,743.23,
"FASCIECTOMY PALM ONLY",P960000794,CDM,960,RC,26121,HCPCS,Outpatient,,,1476.9,738.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",517.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",517.21,517.21,
"REPAIR ""MALLET FINGER""; WO GRA",P960000795,CDM,960,RC,26433,HCPCS,Outpatient,,,1337.37,668.685,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",468.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",468.35,468.35,
"INCISION OF FIBULA",P960000796,CDM,960,RC,27707,HCPCS,Outpatient,,,984.87,492.435,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",344.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",344.9,344.9,
"APPLY WLKR LG LEG CAST",P960000797,CDM,960,RC,29355,HCPCS,Outpatient,,,263.12,131.56,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",120.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",120.87,120.87,
"REM GAUNTLET BOOT OR BODY CAST",P960000798,CDM,960,RC,29700,HCPCS,Outpatient,,,82.67,41.335,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.48,53.48,
"REMOVE FULL ARM OR LEG CAST",P960000799,CDM,960,RC,29705,HCPCS,Outpatient,,,113,56.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,69.87,69.87,69.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.83,54.83,
"ARTHROSCOPY KNEE; ABRAS ARTHRO",P960000800,CDM,960,RC,29879,HCPCS,Outpatient,,,1633.7,816.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",572.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",572.14,572.14,
"INTERNAL NERVE REVISION",P960000801,CDM,960,RC,64727,HCPCS,Outpatient,,,450.7,225.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",154.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",154.78,154.78,
"REM SUTURES BY MD",P960000802,CDM,960,RC,,,Outpatient,,,156.25,78.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",156.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.25,156.25,
"APPLY CLUBFOOT CAST LONG OR SH",P960000803,CDM,960,RC,29450,HCPCS,Outpatient,,,283.4,141.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",124.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,30.69,30.69,30.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",124.68,124.68,
"INPT/TELE FOLLOW UP 15",P960000804,CDM,960,RC,,,Outpatient,,,97,48.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",97,97,
"INPT/TELE FOLLOW UP 25",P960000805,CDM,960,RC,,,Outpatient,,,178.25,89.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",178.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",178.25,178.25,
"INPT/TELE FOLLOW UP 35",P960000806,CDM,960,RC,,,Outpatient,,,256.5,128.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",256.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",256.5,256.5,
"REMOT IMAGE SUBMIT BY PT",P960000808,CDM,960,RC,,,Outpatient,,,22.85,11.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.85,22.85,
"OL DIG E/M SVC 5-10 MIN",P960000809,CDM,960,RC,99421,HCPCS,Outpatient,,,32.35,16.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",10.7,10.7,
"OL DIG E/M SVC 11-20 MIN",P960000810,CDM,960,RC,99422,HCPCS,Outpatient,,,66.18,33.09,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.34,21.34,
"OL DIG E/M SVC 21+ MIN",P960000811,CDM,960,RC,99423,HCPCS,Outpatient,,,105.35,52.675,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.48,34.48,
"QUAL NONMD EST PT 21>MIN",P960000814,CDM,960,RC,,,Outpatient,,,82.08,41.04,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",82.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.08,82.08,
"GLYCOSYLATED HEMOGLOBIN TEST",P960000815,CDM,960,RC,83036,HCPCS,Outpatient,,,24.28,12.14,,,,,,,,0,other,"not separately reimbursement",,,,122.82,9.52,153.52,25,other,"not separately reimbursement",6.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.28,9.04,9.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.52,9.52,9.52,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.52,9.52,9.52,589,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,17.04,13.31,18.10,364,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9.71,9.71,9.71,149,other,"not separately reimbursment",,,,142.21,9.52,177.76,31,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.27,6.27,
"NON-OB TRANSVAG US",P960000816,CDM,960,RC,76830,HCPCS,Outpatient,,,86.33,43.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",82.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,106.94,83.84,106.94,66,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,135.95,131.99,172.38,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,21.39,21.39,21.39,"1 through 10",other,"not separately reimbursment",,,,214.66,122.58,897.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",82.31,82.31,
"BRAND NAME RX DRUG",P960000817,CDM,960,RC,,,Outpatient,,,50.23,25.115,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.23,50.23,
"GENERIC RX DRUG",P960000818,CDM,960,RC,,,Outpatient,,,25.41,12.705,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.41,25.41,
"TREATMENT OF TIBIA FRACTURE",P960000819,CDM,960,RC,,,Outpatient,,,2209.9,1104.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2209.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2209.9,2209.9,
"ASPIRATE/INJ GANGLION CYST",P960000820,CDM,960,RC,20612,HCPCS,Outpatient,,,102.93,51.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.11,53.11,
"CL TX SHLDR DISLOC & FX GT; W",P960000822,CDM,960,RC,23665,HCPCS,Outpatient,,,976.3,488.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",369.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,307.23,307.23,307.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",369.44,369.44,
"UNLISTED EXC PRESSURE ULCER",P960000827,CDM,960,RC,15999,HCPCS,Outpatient,,,1464.25,732.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1464.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1464.25,1464.25,
"UNLISTED PROCEDURE ABD PERITON",P960000834,CDM,960,RC,49999,HCPCS,Outpatient,,,1886.5,943.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1886.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1886.5,1886.5,
"IM ADULT HEPA-HEPB",P960000836,CDM,960,RC,90636,HCPCS,Outpatient,,,440.7,220.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",114.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.35,114.35,
"2VHPV VACCINE 3 DOSE IM",P960000837,CDM,960,RC,90650,HCPCS,Outpatient,,,226.86,113.43,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",150.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",150.08,150.08,
"RIV4 VACC RECOMBINANT DNA IM",P960000838,CDM,960,RC,90682,HCPCS,Outpatient,,,149.6,74.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",54.56,54.56,
"TOTAL VITAL CAPACITY",P960000840,CDM,960,RC,94150,HCPCS,Outpatient,,,332.1,166.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.61,28.61,
"DEVELOPMENTAL SCREEN W/SCORE",P960000841,CDM,960,RC,96110,HCPCS,Outpatient,,,219,109.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.19,11.19,
"TX/PRO/DX INJ SAME DRUG ADDON",P960000842,CDM,960,RC,96376,HCPCS,Outpatient,,,341,170.5,,,,,,,,0,other,"not separately reimbursement",,,,85.88,85.88,154.58,"1 through 10",other,"not separately reimbursement",11.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,101.70,101.70,101.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,99.44,99.44,99.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.4,11.4,
"WOUND(S) CARE NON-SELECTIVE",P960000843,CDM,960,RC,97602,HCPCS,Outpatient,,,419.43,209.715,,,,,,,,0,other,"not separately reimbursement",,,,379.68,379.68,379.68,"1 through 10",other,"not separately reimbursement",95.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,279.76,161.41,388.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,439.63,369.29,439.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",95.63,95.63,
"IRRIGATION TRAY",P960000844,CDM,960,RC,,,Outpatient,,,7.87,3.935,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",7.87,7.87,
"CATH INDW FOLEY 2 WAY SILICONE",P960000845,CDM,960,RC,,,Outpatient,,,70,35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",70,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",70,70,
"COUDE URINARY CATH",P960000846,CDM,960,RC,,,Outpatient,,,23.17,11.585,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.17,23.17,
"RUBBER PESSARY ANY TYPE",P960000847,CDM,960,RC,,,Outpatient,,,211,105.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211,211,
"SURGICAL SUPPLIES",P960000848,CDM,960,RC,,,Outpatient,,,225,112.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",225,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",225,225,
"ADRENALIN EPINEPHRINE INJ 0.1",P960000850,CDM,960,RC,,,Outpatient,,,11.25,5.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",11.25,11.25,
"BETAMETHASONE ACET&SOD PHOSP 3",P960000851,CDM,960,RC,,,Outpatient,,,59.33,29.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.33,59.33,
"DENOSUMAB INJECTION 1 MG",P960000852,CDM,960,RC,,,Outpatient,,,98.65,49.325,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",98.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.65,98.65,
"INJ GARAMYCIN GENTAMICIN TO 80",P960000853,CDM,960,RC,,,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50,50,
"MAKENA, 10 MG",P960000854,CDM,960,RC,,,Outpatient,,,64.54,32.27,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",64.54,64.54,
"TRIAMCINOLONE ACET INJ NOS 10",P960000855,CDM,960,RC,,,Outpatient,,,50,25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50,50,
"VITAMIN K INJ PER 1 MG",P960000856,CDM,960,RC,,,Outpatient,,,39.45,19.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",39.45,39.45,
"BUDESONIDE NON-COMP CON PER 0.",P960000857,CDM,960,RC,,,Outpatient,,,30.39,15.195,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.39,30.39,
"BUDESONIDE COMP CON PER 0.25 M",P960000858,CDM,960,RC,,,Outpatient,,,51.12,25.56,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",51.12,51.12,
"PLASTAZOTE SANDAL EACH",P960000859,CDM,960,RC,,,Outpatient,,,21,10.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21,21,
"ANKLE CONTROL ORTHO PRE OTS",P960000860,CDM,960,RC,,,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",115,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115,115,
"ORAL AZITHROMYCIN DIHYDRATE 1",P960000861,CDM,960,RC,,,Outpatient,,,21.2,10.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.2,21.2,
"SINGLE LENS SPECTACLE MOUNT",P960000863,CDM,960,RC,,,Outpatient,,,275,137.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",275,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",275,275,
"HEARING SCREENING",P960000864,CDM,960,RC,,,Outpatient,,,56,28,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56,56,
"20 P-MASTECTOMY W/LN REMOVAL",P960000865,CDM,960,RC,19302,HCPCS,Outpatient,,,2227.5,1113.75,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",817.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",817.96,817.96,
"20 MAST MOD RAD",P960000866,CDM,960,RC,19307,HCPCS,Outpatient,,,2847.08,1423.54,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1092.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1092.28,1092.28,
"20 BIPOLAR HIP REPLACEMENT",P960000867,CDM,960,RC,27236,HCPCS,Outpatient,,,2359,1179.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1034.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1034.68,1034.68,
"20REP ANEURYSM; ABD AORTA RUPT",P960000868,CDM,960,RC,35082,HCPCS,Outpatient,,,5395,2697.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1834.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1834.32,1834.32,
"20 REPAIR STOMACH LESION",P960000869,CDM,960,RC,43840,HCPCS,Outpatient,,,3373.68,1686.84,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1491.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1491.16,1491.16,
"20 FREEING OF BOWEL ADHESION",P960000870,CDM,960,RC,44005,HCPCS,Outpatient,,,2173,1086.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1198.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1036.64,1036.64,1036.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1198.29,1198.29,
"20 REMOVAL OF SMALL INTESTINE",P960000871,CDM,960,RC,44120,HCPCS,Outpatient,,,2430,1215,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1340.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1340.59,1340.59,
"20 PARTIAL REMOVAL OF COLON",P960000872,CDM,960,RC,44140,HCPCS,Outpatient,,,2664,1332,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1470.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.97,1470.97,
"20 COLOSTOMY",P960000873,CDM,960,RC,44320,HCPCS,Outpatient,,,2385,1192.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1316.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1316.1,1316.1,
"20 REPAIR BOWEL OPENING",P960000874,CDM,960,RC,44620,HCPCS,Outpatient,,,1725,862.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",949.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",949.82,949.82,
"20 INCISION OF GALLBLADDER",P960000875,CDM,960,RC,47480,HCPCS,Outpatient,,,2180.5,1090.25,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",963.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",963.78,963.78,
"20 LAPAROSCOPY; CHOLECYSTECOMY",P960000876,CDM,960,RC,47562,HCPCS,Outpatient,,,1301,650.5,80,,,,,,,0,other,"not separately reimbursement",,,,845.67,845.67,845.67,"1 through 10",other,"not separately reimbursement",721.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,839.25,291.96,1003.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,618.26,618.26,618.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4599.96,321.21,5314.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,559.10,532.47,2543.45,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1173.47,1173.47,1173.47,"1 through 10",other,"not separately reimbursment",,,,10868.31,10868.31,10868.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",721.23,721.23,
"20 REMOVAL OF GALLBLADDER",P960000877,CDM,960,RC,47600,HCPCS,Outpatient,,,2114,1057,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1171.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1166.63,1166.63,1166.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1171.77,1171.77,
"20Cholecystectomy w cholangio",P960000878,CDM,960,RC,47605,HCPCS,Outpatient,,,2789,1394.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1232.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1232.77,1232.77,
"20 EXPL LAPAROTOMY EXPL CELIOT",P960000879,CDM,960,RC,49000,HCPCS,Outpatient,,,1526,763,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",842.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",842.69,842.69,
"20 INTRA-ABD OMENTAL FLAP",P960000886,CDM,960,RC,49905,HCPCS,Outpatient,,,878.63,439.315,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,419.60,419.60,419.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.36,388.36,
"20 TOTAL ABDOMINAL HYSTERECTOM",P960000887,CDM,960,RC,58150,HCPCS,Outpatient,,,2000,1000,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",864.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,805.91,302.95,870.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,968.19,968.19,968.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",864.82,864.82,
"20 LIGATE FALLOPIAN TUBE W CES",P960000888,CDM,960,RC,58611,HCPCS,Outpatient,,,152,76,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,97.01,97.01,97.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.19,66.19,
"20 REMOVAL OF OVARY/ TUBE(S)",P960000889,CDM,960,RC,58720,HCPCS,Outpatient,,,1450,725,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",636.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",636.92,636.92,
"20 DR OVARIAN ABSCESS; ABDOMIN",P960000890,CDM,960,RC,58822,HCPCS,Outpatient,,,1772,886,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",608.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",608.41,608.41,
"20 ROUTINE OB CARE INCL AP C-S",P960000891,CDM,960,RC,59510,HCPCS,Outpatient,,,6263.33,3131.665,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"20 CESAREAN DELIVERY ONLY;",P960000892,CDM,960,RC,59514,HCPCS,Outpatient,,,1820,910,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",611.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1080.26,706.48,1422.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1126.33,1126.33,1126.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,696.29,678.43,749.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,321.23,321.23,321.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",611.82,611.82,
"95 OFFICE VISIT, NEW PT,LEVEL2",P960000894,CDM,960,RC,99202,HCPCS,Outpatient,,,145,72.5,95,,,,,,,0,other,"not separately reimbursement",,,,26.81,26.81,26.81,"1 through 10",other,"not separately reimbursement",52.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,63.98,21.24,69.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,37.63,25.29,49.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,59.44,47.72,67.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.29,41.09,48.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.50,55.70,141.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.9,52.9,
"95OFFICE VISIT, NEW PT, LEVEL3",P960000895,CDM,960,RC,99203,HCPCS,Outpatient,,,272.6,136.3,95,,,,,,,0,other,"not separately reimbursement",,,,62.93,40.23,89.12,14,other,"not separately reimbursement",75.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,70.30,21.27,101.17,93,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.05,63.35,82.95,15,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.99,67.45,105.80,371,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.03,51.08,65.25,120,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,27,other,"not separately reimbursment",,,,97.97,68.52,141.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.02,75.02,
"95OFFICE VISIT, NEW PT, LEVEL4",P960000896,CDM,960,RC,99204,HCPCS,Outpatient,,,407.28,203.64,95,,,,,,,0,other,"not separately reimbursement",,,,100.33,100.33,100.33,"1 through 10",other,"not separately reimbursement",114.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,128.54,88.73,154.01,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,155.73,126.15,155.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,123.21,68.40,162.76,50,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.47,81.24,111.31,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,192.52,"1 through 10",other,"not separately reimbursment",,,,211.08,152.79,265.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.84,114.84,
"95 OFFICE VISIT,NEWPT,LEVEL5",P960000897,CDM,960,RC,99205,HCPCS,Outpatient,,,402,201,95,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",145.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,200.46,192.96,211.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.55,124.55,124.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,121.69,34.45,150.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.70,109.85,118.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.23,145.23,
"95 OFFICE VISIT, EST PT,LEVEL1",P960000898,CDM,960,RC,99211,HCPCS,Outpatient,,,39,19.5,95,,,,,,,0,other,"not separately reimbursement",,,,8.10,8.10,8.10,"1 through 10",other,"not separately reimbursement",16.04,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,17.70,4.46,25.14,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,17.24,17.24,21.71,21,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,15.86,15.86,15.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,261.75,261.75,261.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.04,16.04,
"95 OFFICE VISIT, EST PT,LEVEL3",P960000899,CDM,960,RC,99213,HCPCS,Outpatient,,,221.63,110.815,95,,,,,,,0,other,"not separately reimbursement",,,,50.92,30.92,75.69,53,other,"not separately reimbursement",52.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,45.85,17.39,70.85,189,other,"not separately reimbursment",,,,72.64,23.42,78.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,65.01,33.74,74.46,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.10,54.35,162.76,1044,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.71,31.23,39.90,328,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,105,other,"not separately reimbursment",,,,69.29,37.71,266.75,33,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.28,52.28,
"95 OFFICE VISIT,EST PT, LEVEL2",P960000900,CDM,960,RC,99212,HCPCS,Outpatient,,,84,42,95,,,,,,,0,other,"not separately reimbursement",,,,34.51,33.33,42.13,"1 through 10",other,"not separately reimbursement",31.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,19.48,7.03,45.03,41,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.79,5.58,46.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.22,31.78,162.76,81,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,22.59,20.78,26.54,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,64.87,152.00,"1 through 10",other,"not separately reimbursment",,,,51.54,38.02,263.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.56,31.56,
"95 OFFICE VISIT,EST PT,LEVEL4",P960000901,CDM,960,RC,99214,HCPCS,Outpatient,,,313.45,156.725,95,,,,,,,0,other,"not separately reimbursement",,,,75.23,46.26,131.60,23,other,"not separately reimbursement",75.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,73.73,25.28,103.73,119,other,"not separately reimbursment",,,,101.34,101.34,101.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,88.30,75.53,99.21,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,135.02,81.08,162.76,669,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.68,43.87,56.03,64,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,69,other,"not separately reimbursment",,,,127.59,60.32,266.75,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.99,75.99,
"95 OFFICE VISIT,ESTPT,LEVEL5",P960000902,CDM,960,RC,99215,HCPCS,Outpatient,,,282,141,95,,,,,,,0,other,"not separately reimbursement",,,,142.35,141.42,144.68,"1 through 10",other,"not separately reimbursement",102.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,113.98,29.05,138.94,34,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.95,106.93,130.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,113.89,97.45,140.65,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,73.40,61.10,97.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",102.18,102.18,
"UNLISTED E/M R/S AND CX'S",P960000903,CDM,960,RC,99499,HCPCS,Outpatient,,,276,138,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",276,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,0.55,0.55,0.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",276,276,
"UNLISTED ULTRASOUND",P960000904,CDM,960,RC,76999,HCPCS,Outpatient,,,191.58,95.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",191.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",191.58,191.58,
"20COLECTOMY PART; W SL CECOSTO",P960000905,CDM,960,RC,44141,HCPCS,Outpatient,,,4518.35,2259.175,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1997.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1997.12,1997.12,
"80 COLECTOMY PART; W SL CECOST",P960000906,CDM,960,RC,44141,HCPCS,Outpatient,,,4518.35,2259.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1997.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1997.12,1997.12,
"OPEN TX INTERCONDYLAR SPINE/TU",P960000907,CDM,960,RC,27540,HCPCS,Outpatient,,,2001.53,1000.765,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",700.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",700.93,700.93,
"EXCISION PREPATELLAR BURSA",P960000908,CDM,960,RC,27340,HCPCS,Outpatient,,,915.18,457.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",320.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",320.49,320.49,
"CLOSE ENTEROVES FIST; WO INT/B",P960000909,CDM,960,RC,44660,HCPCS,Outpatient,,,3327.13,1663.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1470.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.59,1470.59,
"CL EV FISTULA W INT RESECT",P960000910,CDM,960,RC,44661,HCPCS,Outpatient,,,3853.2,1926.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1703.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1703.11,1703.11,
"80 P-MASTECTOMY W/LN REMOVAL",P960000911,CDM,960,RC,19302,HCPCS,Outpatient,,,2227.5,1113.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",817.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",817.96,817.96,
"80 MAST, MOD RAD",P960000912,CDM,960,RC,19307,HCPCS,Outpatient,,,2847.08,1423.54,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1092.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1092.28,1092.28,
"80 TX THIGH FRACTURE OPEN",P960000913,CDM,960,RC,27236,HCPCS,Outpatient,,,2359,1179.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1034.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1034.68,1034.68,
"80 REP ANEURYSM;ABD AORTA RUPT",P960000914,CDM,960,RC,35082,HCPCS,Outpatient,,,5395,2697.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1834.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1834.32,1834.32,
"80 REPAIR STOMACH LESION",P960000915,CDM,960,RC,43840,HCPCS,Outpatient,,,3373.68,1686.84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1491.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1491.16,1491.16,
"80 FREEZING OF BOWEL ADHESION",P960000916,CDM,960,RC,44005,HCPCS,Outpatient,,,2173,1086.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1198.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1036.64,1036.64,1036.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1198.29,1198.29,
"80 REMOVAL OF SMALL INTESTINE",P960000917,CDM,960,RC,44120,HCPCS,Outpatient,,,2430,1215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1340.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1340.59,1340.59,
"80 PART REM COLON W/ANATOMOSIS",P960000918,CDM,960,RC,44140,HCPCS,Outpatient,,,2664,1332,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1470.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1470.97,1470.97,
"80 COLOSTOMY",P960000919,CDM,960,RC,44320,HCPCS,Outpatient,,,2385,1192.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1316.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1316.1,1316.1,
"80 REPAIR BOWEL OPENING",P960000920,CDM,960,RC,44620,HCPCS,Outpatient,,,1725,862.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",949.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",949.82,949.82,
"80 INCISION OF GALLBLADDER",P960000921,CDM,960,RC,47480,HCPCS,Outpatient,,,2180.5,1090.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",963.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",963.78,963.78,
"80 LAPOROSCOPIC CHOLECYSTECTOM",P960000922,CDM,960,RC,47562,HCPCS,Outpatient,,,1301,650.5,,,,,,,,0,other,"not separately reimbursement",,,,845.67,845.67,845.67,"1 through 10",other,"not separately reimbursement",721.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,839.25,291.96,1003.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,618.26,618.26,618.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4599.96,321.21,5314.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,559.10,532.47,2543.45,11,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1173.47,1173.47,1173.47,"1 through 10",other,"not separately reimbursment",,,,10868.31,10868.31,10868.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",721.23,721.23,
"80 REMOVAL OF GALLBLADDER",P960000923,CDM,960,RC,47600,HCPCS,Outpatient,,,2114,1057,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1171.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1166.63,1166.63,1166.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1171.77,1171.77,
"80Cholecystectomy w cholangio",P960000924,CDM,960,RC,47605,HCPCS,Outpatient,,,2789,1394.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1232.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1232.77,1232.77,
"80 EXPLORATION OF ABDOMEN",P960000925,CDM,960,RC,49000,HCPCS,Outpatient,,,1526,763,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",842.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",842.69,842.69,
"80 INTRA-ABD OMENTAL FLAP",P960000932,CDM,960,RC,49905,HCPCS,Outpatient,,,878.63,439.315,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,419.60,419.60,419.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.36,388.36,
"80 TOTAL HYSTERECTOMY",P960000933,CDM,960,RC,58150,HCPCS,Outpatient,,,2000,1000,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",864.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,805.91,302.95,870.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,968.19,968.19,968.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",864.82,864.82,
"80 LIGATE OVI DUCT(S) ADD ON",P960000934,CDM,960,RC,58611,HCPCS,Outpatient,,,152,76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,97.01,97.01,97.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",66.19,66.19,
"80 REMOVAL OF OVARY/TUBE(S)",P960000935,CDM,960,RC,58720,HCPCS,Outpatient,,,1450,725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",636.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",636.92,636.92,
"80 DR OVARIAN ABSCESS;ABDOMIN",P960000936,CDM,960,RC,58822,HCPCS,Outpatient,,,1722,861,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",608.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",608.41,608.41,
"80 CESAREAN DELIVERY",P960000937,CDM,960,RC,59510,HCPCS,Outpatient,,,6263.33,3131.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"80 CESAREAN DELIVERY ONLY",P960000938,CDM,960,RC,59514,HCPCS,Outpatient,,,1820,910,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",611.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1080.26,706.48,1422.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1126.33,1126.33,1126.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,696.29,678.43,749.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,321.23,321.23,321.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",611.82,611.82,
"DR OVARIAN ABSCESS",P960000939,CDM,960,RC,,,Outpatient,,,1722,861,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1722,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1722,1722,
"DRAIN FINGER ABSC; SIMPLE",P960000940,CDM,960,RC,26010,HCPCS,Outpatient,,,340.55,170.275,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",258.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",258.4,258.4,
"LAP; CHOLECYSTECTOMY W CHOLANG",P960000941,CDM,960,RC,47563,HCPCS,Outpatient,,,1776.2,888.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",785.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,886.09,680.11,1092.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,686.06,540.55,3034.40,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,578.72,578.72,578.72,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.08,785.08,
"SKIN SPLT GRFT TRNK/ARM/LEG 10",P960000942,CDM,960,RC,15100,HCPCS,Outpatient,,,1763,881.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",780.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",780.72,780.72,
"DRAINAGE ABDOM ABSCESS OPEN",P960000945,CDM,960,RC,49020,HCPCS,Outpatient,,,3950,1975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1746.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1746.2,1746.2,
"BONE BIOPSY OPEN SUPERFICIAL",P960000946,CDM,960,RC,20240,HCPCS,Outpatient,,,365,182.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",127.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.75,127.75,
"DIAGNOSTIC ANOSCOPY SPX",P960000947,CDM,960,RC,46600,HCPCS,Outpatient,,,100.5,50.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",100.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,40.91,40.91,40.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,54.39,54.39,54.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,79.78,79.78,96.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.5,100.5,
"EX ARM/ELBOW TUM DEEP 5 CM/>",P960000948,CDM,960,RC,24073,HCPCS,Outpatient,,,1717.45,858.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",601.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",601.45,601.45,
"MANIP SHLDR JOINT UNDER ANESTH",P960000949,CDM,960,RC,23700,HCPCS,Outpatient,,,482,241,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",168.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1609.45,1609.45,1609.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.78,168.78,
"DIL URETHR STRICT FILIF/FOLLOW",P960000950,CDM,960,RC,53620,HCPCS,Outpatient,,,218.03,109.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",122.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.57,122.57,
"REM MNTR PHYSIOL PARAM SETUP",P960000951,CDM,960,RC,99453,HCPCS,Outpatient,,,46.93,23.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12.62,12.62,
"REM MNTR PHYSIOL PARAM DEV",P960000952,CDM,960,RC,99454,HCPCS,Outpatient,,,156.1,78.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.15,42.15,
"REM PHYSIOL MNTR 1ST 20 MIN",P960000953,CDM,960,RC,99457,HCPCS,Outpatient,,,129.03,64.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.39,35.39,
"REM PHYSIOL MNTR EA ADDL 20",P960000954,CDM,960,RC,99458,HCPCS,Outpatient,,,105.55,52.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.05,29.05,
"CHRON CARE MGMT SRVC 20 MIN",P960000955,CDM,960,RC,99490,HCPCS,Outpatient,,,152,76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,46.20,46.20,46.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.42,47.42,47.42,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",29.05,29.05,
"REP RECURENT ING HERNIA ANY AG",P960000956,CDM,960,RC,49521,HCPCS,Outpatient,,,1776.25,888.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",785.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.1,785.1,
"20 REP RECURENT ING HERNIA AN",P960000957,CDM,960,RC,49521,HCPCS,Outpatient,,,1776.25,888.125,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",785.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.1,785.1,
"80 REP RECURENT ING HERNIA AN",P960000958,CDM,960,RC,49521,HCPCS,Outpatient,,,1776.25,888.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",785.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",785.1,785.1,
"DRAIN BL W/CATH INSERTION",P960000959,CDM,960,RC,51102,HCPCS,Outpatient,,,364.8,182.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",197,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1615.10,1615.10,1615.10,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",197,197,
"INTERROG DEV EVAL SCRMS IP",P960000960,CDM,960,RC,93291,HCPCS,Outpatient,,,46.83,23.415,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",34.45,34.45,
"DX BRONCHOSCOPE/WASH",P960000961,CDM,960,RC,31622,HCPCS,Outpatient,,,330,165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",216.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",216.29,216.29,
"Scrotal Exploration",P960000962,CDM,960,RC,55110,HCPCS,Outpatient,,,968.28,484.14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",332.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",332.51,332.51,
"Sigmoidoscopy w lesion remv",P960000965,CDM,960,RC,45338,HCPCS,Outpatient,,,757.43,378.715,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",306.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.29,95.29,95.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",306.43,306.43,
"Exc Rect Tum Transanal part",P960000966,CDM,960,RC,45171,HCPCS,Outpatient,,,1499.1,749.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",662.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,783.23,783.23,783.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1313.60,634.74,1992.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",662.6,662.6,
"INS CATH REN ART 1ST BILAT",P960000967,CDM,960,RC,36252,HCPCS,Outpatient,,,890.48,445.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",890.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",890.48,890.48,
"Excision of lesion sperm cord",P960000968,CDM,960,RC,55520,HCPCS,Outpatient,,,1124.68,562.34,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",386.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",386.21,386.21,
"N H Visit initial detail",P960000969,CDM,960,RC,99304,HCPCS,Outpatient,,,201.1,100.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",63.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",63.73,63.73,
"N H Visit initial Moderate",P960000970,CDM,960,RC,99305,HCPCS,Outpatient,,,290.48,145.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.42,91.42,
"N H Visit Initial High Compex",P960000971,CDM,960,RC,99306,HCPCS,Outpatient,,,374.33,187.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.85,117.85,
"FRAC/DIS PROC FOREARM/WRIST",P960000972,CDM,960,RC,25660,HCPCS,Outpatient,,,1021.98,510.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",357.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",357.89,357.89,
"Repair Incompl Circumcision",P960000973,CDM,960,RC,54163,HCPCS,Outpatient,,,528.05,264.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",186.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.31,186.31,
"US Pelvic Non OB Complete",P960000974,CDM,960,RC,76856,HCPCS,Outpatient,,,76.18,38.09,,,,,,,,0,other,"not separately reimbursement",,,,774.97,774.97,774.97,"1 through 10",other,"not separately reimbursement",73.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,104.62,104.62,104.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,99.85,83.84,106.94,16,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,158.58,137.30,175.74,32,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,797.63,797.63,797.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",73.36,73.36,
"80 Rep Inguinal Hernia",P960000975,CDM,960,RC,49507,HCPCS,Outpatient,,,1310.2,655.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",641.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3510.49,3479.69,3541.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",641.63,641.63,
"20 Repair Inguinal Hernia",P960000976,CDM,960,RC,49507,HCPCS,Outpatient,,,1310.2,655.1,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",641.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3510.49,3479.69,3541.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",641.63,641.63,
"Omentectomy epiploectomy",P960000977,CDM,960,RC,49255,HCPCS,Outpatient,,,1771.35,885.675,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",863.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",863.42,863.42,
"80 Removal of Ovary(s)",P960000978,CDM,960,RC,58940,HCPCS,Outpatient,,,1258.9,629.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",460.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.98,460.98,
"20 Removal of Ovary(s)",P960000979,CDM,960,RC,58940,HCPCS,Outpatient,,,1258.9,629.45,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",460.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",460.98,460.98,
"Mastectomy w LN removal",P960000980,CDM,960,RC,19302,HCPCS,Outpatient,,,2019.35,1009.675,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",817.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",817.96,817.96,
"Aneurysm Abd Aorta Rupture",P960000981,CDM,960,RC,35082,HCPCS,Outpatient,,,4735.93,2367.965,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1834.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1834.32,1834.32,
"repair stomach lesion",P960000982,CDM,960,RC,43840,HCPCS,Outpatient,,,3019.15,1509.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1491.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1491.16,1491.16,
"Colectomy part w sl cecosto",P960000983,CDM,960,RC,44141,HCPCS,Outpatient,,,4052.13,2026.065,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1997.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1997.12,1997.12,
"Cholecystectomy w cholangriogr",P960000984,CDM,960,RC,47605,HCPCS,Outpatient,,,2506.85,1253.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1232.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1232.77,1232.77,
"Intra Abd Omental Flap",P960000985,CDM,960,RC,49905,HCPCS,Outpatient,,,777.45,388.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,419.60,419.60,419.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.36,388.36,
"Routine foot care- PT LOS",P960000986,CDM,960,RC,,,Outpatient,,,53.8,26.9,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.8,53.8,
"Laparoscopy, surg w Lysis adh",P960000987,CDM,960,RC,58660,HCPCS,Outpatient,,,1650.1,825.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",579.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",579.81,579.81,
"Biopsy of nail",P960000988,CDM,960,RC,11755,HCPCS,Outpatient,,,149.95,74.975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",87.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",87.83,87.83,
"Gastrostomy repl w image guid",P960000989,CDM,960,RC,49450,HCPCS,Outpatient,,,160.25,80.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",160.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,739.19,739.19,739.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.25,160.25,
"80 Gastrostomy Rep w Img guidn",P960000990,CDM,960,RC,49450,HCPCS,Outpatient,,,160.25,80.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",160.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,739.19,739.19,739.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.25,160.25,
"20 Gastrostomy rep w Img guidn",P960000991,CDM,960,RC,49450,HCPCS,Outpatient,,,160.25,80.125,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",160.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,739.19,739.19,739.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",160.25,160.25,
"Gastrostomy rep w/o Im guidnce",P960000992,CDM,960,RC,43762,HCPCS,Outpatient,,,91.2,45.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,191.75,191.75,191.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.94,41.94,41.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.2,91.2,
"80Gastrostomy rep w/o Im guidn",P960000993,CDM,960,RC,43762,HCPCS,Outpatient,,,91.2,45.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,191.75,191.75,191.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.94,41.94,41.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.2,91.2,
"20Gastrostomy rep w/o Im guidn",P960000994,CDM,960,RC,43762,HCPCS,Outpatient,,,91.2,45.6,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,191.75,191.75,191.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,41.94,41.94,41.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.2,91.2,
"Dis site telehealth RHC",P960000995,CDM,960,RC,,,Outpatient,,,164.83,82.415,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",164.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",164.83,164.83,
"Breast Biopsy w plcmt of devic",P960000996,CDM,960,RC,19081,HCPCS,Outpatient,,,402.43,201.215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",402.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1244.00,1244.00,1244.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.43,402.43,
"Frenulotomy of penis",P960000997,CDM,960,RC,54164,HCPCS,Outpatient,,,468.58,234.29,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",164.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",164.63,164.63,
"Neg Press Wound Tx >50 cm",P960000998,CDM,960,RC,97606,HCPCS,Outpatient,,,68.35,34.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",60.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,19.77,19.77,19.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,883.94,883.94,883.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",60.1,60.1,
"Lt Compres band >=3""<5/yd",P960000999,CDM,960,RC,,,Outpatient,,,68.35,34.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",68.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",68.35,68.35,
"Trans Care Mgmt 14 day d/c",P960001000,CDM,960,RC,99495,HCPCS,Outpatient,,,351.98,175.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",129.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",129.25,129.25,
"Trans care Mgmt 7 day d/c",P960001001,CDM,960,RC,99496,HCPCS,Outpatient,,,478.95,239.475,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",170.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",170.62,170.62,
"Perq Device Breast 1st",P960001002,CDM,960,RC,19281,HCPCS,Outpatient,,,242.6,121.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",220.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",220.83,220.83,
"Strapping of toes",P960001003,CDM,960,RC,29550,HCPCS,Outpatient,,,27.83,13.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",16.41,16.41,
"Arthroscopy knee; rem loose FB",P960001004,CDM,960,RC,29874,HCPCS,Outpatient,,,1307.18,653.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",464.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",464.84,464.84,
Orthovisc,P960001005,CDM,960,RC,,,Outpatient,,,321.38,160.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",321.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",321.38,321.38,
"Lap Hysterectomy 250g or less",P960001006,CDM,960,RC,58570,HCPCS,Outpatient,,,1951.55,975.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",679.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",679.92,679.92,
"Lap Hyst 250g or less r T/O",P960001007,CDM,960,RC,58571,HCPCS,Outpatient,,,2198.48,1099.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",766.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,793.81,793.81,793.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",766.73,766.73,
"Lap Hysterectomy over 250g",P960001008,CDM,960,RC,58572,HCPCS,Outpatient,,,2520.28,1260.14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",883.35,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",883.35,883.35,
"Lap Hyst >250g w rem T/O",P960001009,CDM,960,RC,58573,HCPCS,Outpatient,,,2954.53,1477.265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1035.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1035.99,1035.99,
"LAP ENTEROLYSIS",P960001910,CDM,960,RC,44180,HCPCS,Outpatient,,,2208.5,1104.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1007.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,858.11,858.11,858.11,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,51.81,51.81,51.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1007.93,1007.93,
"PERC BX OR EXC LN; SUPERFICIAL",P960001911,CDM,960,RC,38505,HCPCS,Outpatient,,,169.2,84.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",104.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1204.80,1204.80,1204.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1453.42,1312.64,1594.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",104.12,104.12,
"Mastectomy Partial",P960001912,CDM,960,RC,19301,HCPCS,Outpatient,,,1585.1,792.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",595.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",595.18,595.18,
"80 Mastectomy Partial",P960001913,CDM,960,RC,19301,HCPCS,Outpatient,,,1585.1,792.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",595.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",595.18,595.18,
"20 Mastectomy Partial",P960001914,CDM,960,RC,19301,HCPCS,Outpatient,,,1585.1,792.55,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",595.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",595.18,595.18,
"BONE BX TR/NDL; SUPERF",P960001915,CDM,960,RC,20220,HCPCS,Outpatient,,,214.05,107.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",212.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",212.36,212.36,
"Exc Forearm lesion sc <3cm",P960001916,CDM,960,RC,25075,HCPCS,Outpatient,,,767.03,383.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,480.86,480.86,480.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.68,434.68,
"Tenolysis,flx tnd plm/finger",P960001917,CDM,960,RC,26440,HCPCS,Outpatient,,,1620.3,810.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",541.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.12,541.12,
"Tenolysis,flx tnd plm/finger ea",P960001917,CDM,960,RC,26440,HCPCS,Outpatient,,,1620.3,810.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",541.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.12,541.12,
"VBAC,delv proc after prev Csec",P960001918,CDM,960,RC,59610,HCPCS,Outpatient,,,5925.2,2962.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"80 VBAC,delv proc p prev Csect",P960001919,CDM,960,RC,59610,HCPCS,Outpatient,,,5925.2,2962.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"20 VBAC,delv proc p prev Csect",P960001920,CDM,960,RC,59610,HCPCS,Outpatient,,,5925.2,2962.6,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1487.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1487.5,1487.5,
"Endometrial Cryoablation W/US",P960001921,CDM,960,RC,58356,HCPCS,Outpatient,,,864.38,432.19,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",864.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",864.38,864.38,
"Wound Expl penetr wound neck",P960001922,CDM,960,RC,20100,HCPCS,Outpatient,,,1450.93,725.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",523.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",523.39,523.39,
"80wound expl penetr wound neck",P960001923,CDM,960,RC,20100,HCPCS,Outpatient,,,1450.93,725.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",523.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",523.39,523.39,
"20wound expl penetr wound neck",P960001924,CDM,960,RC,20100,HCPCS,Outpatient,,,1450.93,725.465,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",523.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",523.39,523.39,
"Wound expl pentr chest wound",P960001925,CDM,960,RC,20101,HCPCS,Outpatient,,,504.78,252.39,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",409.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",409.22,409.22,
"80Wound expl pentr chest wound",P960001926,CDM,960,RC,20101,HCPCS,Outpatient,,,504.78,252.39,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",409.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",409.22,409.22,
"20Wound expl pentr chest wound",P960001927,CDM,960,RC,20101,HCPCS,Outpatient,,,504.78,252.39,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",409.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",409.22,409.22,
"Wound expl pen abd/flnk/back",P960001928,CDM,960,RC,20102,HCPCS,Outpatient,,,612.98,306.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",440.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",440.4,440.4,
"80Wound expl pen abd/flnk/back",P960001929,CDM,960,RC,20102,HCPCS,Outpatient,,,612.98,306.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",440.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",440.4,440.4,
"20Wound expl pen abd/flnk/back",P960001930,CDM,960,RC,20102,HCPCS,Outpatient,,,612.98,306.49,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",440.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",440.4,440.4,
"Wound expl penetr extremities",P960001931,CDM,960,RC,20103,HCPCS,Outpatient,,,835.45,417.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",496.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.95,496.95,
"80wound expl extremities",P960001932,CDM,960,RC,20103,HCPCS,Outpatient,,,835.45,417.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",496.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.95,496.95,
"20Wound expl extremities",P960001933,CDM,960,RC,20103,HCPCS,Outpatient,,,835.45,417.725,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",496.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",496.95,496.95,
"LSH Uterus 250gm or less",P960001934,CDM,960,RC,58541,HCPCS,Outpatient,,,1781.48,890.74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",623.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,623.29,
"80 LSH Uterus 250gm or less",P960001935,CDM,960,RC,58541,HCPCS,Outpatient,,,1781.48,890.74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",623.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,623.29,
"20 LSH Uterus 250gm or less",P960001936,CDM,960,RC,58541,HCPCS,Outpatient,,,1781.48,890.74,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",623.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",623.29,623.29,
"LSH W/T/O UT 250 G OR LESS",P960001937,CDM,960,RC,58542,HCPCS,Outpatient,,,2026.25,1013.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",709.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",709.27,709.27,
"80LSH W/T/O UT 250 G OR LESS",P960001938,CDM,960,RC,58542,HCPCS,Outpatient,,,2026.25,1013.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",709.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",709.27,709.27,
"20LSH W/T/O UT 250 G OR LESS",P960001939,CDM,960,RC,58542,HCPCS,Outpatient,,,2026.25,1013.125,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",709.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",709.27,709.27,
"LSH UTERUS ABOVE 250 G",P960001940,CDM,960,RC,58543,HCPCS,Outpatient,,,2055.38,1027.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",720.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.3,720.3,
"80 LSH UTERUS ABOVE 250 GM",P960001941,CDM,960,RC,58543,HCPCS,Outpatient,,,2055.38,1027.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",720.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.3,720.3,
"20 LSH UTERUS ABOVE 250 GM",P960001942,CDM,960,RC,58543,HCPCS,Outpatient,,,2055.38,1027.69,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",720.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",720.3,720.3,
"LSH W/T/O UTERUS ABOVE 250 G",P960001943,CDM,960,RC,58544,HCPCS,Outpatient,,,2213.88,1106.94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",775.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",775.88,775.88,
"80LSH W/T/O UTERUS ABOVE 250G",P960001944,CDM,960,RC,58544,HCPCS,Outpatient,,,2213.88,1106.94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",775.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",775.88,775.88,
"20LSH W/T/O UTERUS ABOVE 250 G",P960001945,CDM,960,RC,58544,HCPCS,Outpatient,,,2213.88,1106.94,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",775.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",775.88,775.88,
"80 Repair Bladder Wound",P960001946,CDM,960,RC,51860,HCPCS,Outpatient,,,1807.68,903.84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",625.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",625.54,625.54,
"20 Repair Bladder Wound",P960001947,CDM,960,RC,51860,HCPCS,Outpatient,,,1807.68,903.84,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",625.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",625.54,625.54,
"80 D & C diagnostic",P960001948,CDM,960,RC,58120,HCPCS,Outpatient,,,570.6,285.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",238.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1364.25,450.19,2278.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1152.38,1152.38,1152.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.51,238.51,
"20 D & C diagnostic",P960001949,CDM,960,RC,58120,HCPCS,Outpatient,,,570.6,285.3,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",238.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1364.25,450.19,2278.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1152.38,1152.38,1152.38,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",238.51,238.51,
"Exc Malig Lsn F/E/E/N/L 0.5cm<",P960001950,CDM,960,RC,11640,HCPCS,Outpatient,,,305.5,152.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",182.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",182.17,182.17,
"Induced Abortion by Dil & Evac",P960001951,CDM,960,RC,59841,HCPCS,Outpatient,,,2969.45,1484.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",271.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",271.05,271.05,
"hysteroscopy endomet ablation",P960001952,CDM,960,RC,58563,HCPCS,Outpatient,,,597.73,298.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",597.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4343.79,3847.36,4840.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",597.73,597.73,
"Office consultation",P960001953,CDM,960,RC,99245,HCPCS,Outpatient,,,535.75,267.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",141.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",141.61,141.61,
"Mastotomy w/ exploration",P960001954,CDM,960,RC,19020,HCPCS,Outpatient,,,752.8,376.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",424.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.21,424.21,
"Secondary closure Surg wound",P960001955,CDM,960,RC,13160,HCPCS,Outpatient,,,1929.65,964.825,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",724.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",724.9,724.9,
"Incision of Gallbladder",P960001956,CDM,960,RC,47480,HCPCS,Outpatient,,,2126,1063,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",963.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",963.78,963.78,
"MUGA multi w W/M & EF",P960001957,CDM,960,RC,78473,HCPCS,Outpatient,,,171.63,85.815,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",171.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",171.63,171.63,
"Rem & Repl PM Gen Single",P960001958,CDM,960,RC,33227,HCPCS,Outpatient,,,814.15,407.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",284.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",284.59,284.59,
"Relocation of PM Pocket",P960001959,CDM,960,RC,33222,HCPCS,Outpatient,,,823.18,411.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",285.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",285.3,285.3,
"CREP F/G/H/F 2.6-7.5 cm",P960001960,CDM,960,RC,13132,HCPCS,Outpatient,,,735.18,367.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",430.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",430.43,430.43,
"CREP H/A/G/Ext Each Addtl 5cm<",P960001961,CDM,960,RC,13133,HCPCS,Outpatient,,,305.93,152.965,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",157.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",157.79,157.79,
"Correction Hallux Valgus",P960001962,CDM,960,RC,28292,HCPCS,Outpatient,,,1175.03,587.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",631.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,344.01,344.01,344.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",631.68,631.68,
"MTP Jnt Capsulotomy ea sngl jn",P960001963,CDM,960,RC,28270,HCPCS,Outpatient,,,816.08,408.04,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",429.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",429.3,429.3,
"Destruction Benign les 15>",P960001964,CDM,960,RC,17111,HCPCS,Outpatient,,,196.68,98.34,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",117.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",117.65,117.65,
"CL Tx Post Hip Arthr Dislc w/o",P960001965,CDM,960,RC,27265,HCPCS,Outpatient,,,260.48,130.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",260.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",260.48,260.48,
"Excn Pilondial Cyst/sinus smpl",P960001966,CDM,960,RC,11770,HCPCS,Outpatient,,,448.7,224.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",279.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",279.76,279.76,
"Excn Pilondial Cyst/sinus Extn",P960001967,CDM,960,RC,11771,HCPCS,Outpatient,,,1072.55,536.275,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",541.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2878.22,2878.22,2878.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",541.58,541.58,
"Excn Pilondial Cyst/Sinus cmpl",P960001968,CDM,960,RC,11772,HCPCS,Outpatient,,,1416.8,708.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",656.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",656.49,656.49,
"Destr of Penis Lesion extensiv",P960001969,CDM,960,RC,54065,HCPCS,Outpatient,,,413.98,206.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",185.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",185.95,185.95,
"Zilretta Inj 1mg",P960001970,CDM,960,RC,,,Outpatient,,,44.73,22.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",44.73,44.73,
"Total Contact Leg Cast",P960001971,CDM,960,RC,29445,HCPCS,Outpatient,,,244.28,122.14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",112.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",112.51,112.51,
"Exc Foot Cyst/ Ganglion",P960001972,CDM,960,RC,28090,HCPCS,Outpatient,,,748.9,374.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",407.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,425.05,425.05,425.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1261.80,1261.80,1261.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,321.90,321.90,321.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",407.15,407.15,
"80 Partial Hysterectomy",P960001973,CDM,960,RC,58180,HCPCS,Outpatient,,,2234.63,1117.315,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",823.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",823.33,823.33,
"20 Partial hysterectomy",P960001974,CDM,960,RC,58180,HCPCS,Outpatient,,,2334.63,1167.315,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",823.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",823.33,823.33,
"Wound Pref F/N/HF/G 100Sq CM1%",P960001975,CDM,960,RC,15004,HCPCS,Outpatient,,,635.4,317.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",361.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",361.68,361.68,
"Repr Foot Extensor Tendon Each",P960001976,CDM,960,RC,28208,HCPCS,Outpatient,,,775.63,387.815,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",419.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",419.25,419.25,
"Inj Corporo cavernosa w/ pharm",P960001977,CDM,960,RC,54235,HCPCS,Outpatient,,,175.25,87.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",75.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.15,75.15,
"Abd. Aorta w Runoffs",P960001978,CDM,960,RC,75630,HCPCS,Outpatient,,,232.65,116.325,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",114.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.54,114.54,
"Right Heart Cath",P960001979,CDM,960,RC,93451,HCPCS,Outpatient,,,312.85,156.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",312.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",312.85,312.85,
"Rep Elblow Med.Ligament",P960001980,CDM,960,RC,24345,HCPCS,Outpatient,,,1725.58,862.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",607.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",607.23,607.23,
"Colposcopy Leep W Bx",P960001981,CDM,960,RC,57460,HCPCS,Outpatient,,,388.1,194.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",258.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2741.54,2741.54,2741.54,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",258.76,258.76,
"Corp Cavernosa-Saph vein shunt",P960001982,CDM,960,RC,54420,HCPCS,Outpatient,,,1713.18,856.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",605.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",605.54,605.54,
"PART EXC BONE FEMUR PROX TIBIA",P960001983,CDM,960,RC,27360,HCPCS,Outpatient,,,2182.83,1091.415,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",758.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",758.84,758.84,
"Cardiovascular Stress test",P960001984,CDM,960,RC,93015,HCPCS,Outpatient,,,172.95,86.475,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",56.64,56.64,
"U S Guide vascular access",P960001985,CDM,960,RC,76937,HCPCS,Outpatient,,,33.85,16.925,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,549.12,549.12,549.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.51,24.51,
"PRQ CARDIAC ANGIOPLAST 1 ART",P960001986,CDM,960,RC,92920,HCPCS,Outpatient,,,1255.53,627.765,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",620.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,98.04,98.04,98.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,384.34,384.34,384.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",620.85,620.85,
"ECG 12 lead Interp/Report only",P960001987,CDM,960,RC,93010,HCPCS,Outpatient,,,20.33,10.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.89,6.89,
"Aortic Balloon plcmt Percutan",P960001988,CDM,960,RC,33967,HCPCS,Outpatient,,,620.2,310.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",217.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.76,217.76,
"Tis Trnfr Trunk 10sq cm <",P960001990,CDM,960,RC,14000,HCPCS,Outpatient,,,1204.63,602.315,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",563.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",563.7,563.7,
"Coronary Art Angiogram S & I",P960001991,CDM,960,RC,93454,HCPCS,Outpatient,,,571.3,285.65,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",571.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,22.05,22.05,22.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.46,86.46,86.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",571.3,571.3,
"Repair ankle ligament",P960001992,CDM,960,RC,27698,HCPCS,Outpatient,,,1555.83,777.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",554.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",554.82,554.82,
"ECHO TRANSESOPHAG R-T 2D W/PRB",P960001993,CDM,960,RC,93312,HCPCS,Outpatient,,,266.88,133.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",196.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,97.45,97.45,97.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",196.86,196.86,
"Insert Non Tunnel CV Cath",P960001994,CDM,960,RC,36556,HCPCS,Outpatient,,,205,102.5,,,,,,,,0,other,"not separately reimbursement",,,,8800.54,8800.54,8800.54,"1 through 10",other,"not separately reimbursement",177.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2481.58,2481.58,2481.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2014.92,2014.92,2014.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,633.05,633.05,633.05,"1 through 10",other,"not separately reimbursment",,,,2473.68,2473.68,2473.68,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.74,177.74,
"Psy Tx Crisis initial 60 min",P960001997,CDM,960,RC,90839,HCPCS,Outpatient,,,355.05,177.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",143.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",143.41,143.41,
"Psy Tx Crisis ea addtl 30 min",P960001998,CDM,960,RC,90840,HCPCS,Outpatient,,,149.9,74.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",71.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",71.7,71.7,
"Triamcinolone Acetonide 1mg",P960001999,CDM,960,RC,,,Outpatient,,,13.23,6.615,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",13.23,13.23,
"EXC FOOT/TOE TUM SC < 1.5 CM",P960002000,CDM,960,RC,28043,HCPCS,Outpatient,,,635.55,317.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",342.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",342.56,342.56,
"Open tx radial shaft fracture",P960002001,CDM,960,RC,25515,HCPCS,Outpatient,,,1628.5,814.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",578.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",578.59,578.59,
"COLONOSCOPY SUBMUCOUS NJX",P960002002,CDM,960,RC,45381,HCPCS,Outpatient,,,487.73,243.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",458.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,156.09,117.02,156.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,12.81,12.81,541.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.57,118.57,118.57,"1 through 10",other,"not separately reimbursment",,,,581.02,581.02,581.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",458.01,458.01,
"Drainage of mouth lesion",P960002003,CDM,960,RC,41017,HCPCS,Outpatient,,,848.1,424.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",493.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",493.99,493.99,
"Angriography extremity unilat",P960002004,CDM,960,RC,75710,HCPCS,Outpatient,,,385.98,192.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",109.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",109.79,109.79,
"Endometr Ablate Thermal",P960002005,CDM,960,RC,58353,HCPCS,Outpatient,,,561.03,280.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",561.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",561.03,561.03,
"Mobile cardiac Telemetry",P960002006,CDM,960,RC,93228,HCPCS,Outpatient,,,63.23,31.615,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,33.63,26.57,37.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,18.64,16.03,21.63,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,20.05,7.71,20.05,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",21.63,21.63,
"Cardiac Event monitor hook-up",P960002007,CDM,960,RC,93270,HCPCS,Outpatient,,,21.33,10.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.89,6.89,
"Event Monitor Rep & Interp",P960002008,CDM,960,RC,93272,HCPCS,Outpatient,,,61.38,30.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",20.74,20.74,
"Hysterectomy after c section",P960002009,CDM,960,RC,59525,HCPCS,Outpatient,,,1135.9,567.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",323.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",323.96,323.96,
"Exision Malig lesion level 2",P960002010,CDM,960,RC,11620,HCPCS,Outpatient,,,297.88,148.94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",177.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",177.96,177.96,
"Colonoscopy w lesion removal",P960002011,CDM,960,RC,45384,HCPCS,Outpatient,,,551.03,275.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",513.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,711.74,267.05,970.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,88.93,88.93,88.93,"1 through 10",other,"not separately reimbursment",,,,581.02,581.02,581.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",513.83,513.83,
"Endoluminal Coron ivus oct 1st",P960002012,CDM,960,RC,92978,HCPCS,Outpatient,,,226.83,113.415,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",216.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,123.76,38.79,141.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,68.80,68.80,68.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",216.86,216.86,
"DBRDMT SKN SUBQ T/M/F ABD WALL",P960002013,CDM,960,RC,11005,HCPCS,Outpatient,,,1853.45,926.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",710.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,570.59,570.59,570.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",710.24,710.24,
"EXC TUMR SFT TIS FACE/SCLP 2CM",P960002014,CDM,960,RC,21012,HCPCS,Outpatient,,,817.38,408.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",291.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1596.81,1596.81,1596.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",291.23,291.23,
"Debrdmnt open wnd ea addt 20sq",P960002015,CDM,960,RC,97598,HCPCS,Outpatient,,,111.98,55.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,40.99,40.99,40.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.37,53.37,
"Lysis labial adhesions",P960002016,CDM,960,RC,56441,HCPCS,Outpatient,,,371.43,185.715,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.58,139.58,
"Inc Drn,cmplx, post op wound",P960002017,CDM,960,RC,10180,HCPCS,Outpatient,,,428.35,214.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",228.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",228.9,228.9,
"Transesophageal Tee",P960002018,CDM,960,RC,93355,HCPCS,Outpatient,,,558.6,279.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",188.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,164.58,164.58,164.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",188.36,188.36,
"PLACE GASTROSTOMY TUBE PERC",P960002019,CDM,960,RC,49440,HCPCS,Outpatient,,,494.13,247.065,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",494.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1495.65,1495.65,1495.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",494.13,494.13,
"REMOVL PACEMAKR ELECTRODE DUAL",P960002020,CDM,960,RC,33235,HCPCS,Outpatient,,,1531.53,765.765,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",536.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",536.27,536.27,
"RMOVL PERM PM PULSE GEN ONLY",P960002021,CDM,960,RC,33233,HCPCS,Outpatient,,,560.83,280.415,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",193.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",193.8,193.8,
"PARTIAL REMOVAL OF COLON",P960002022,CDM,960,RC,44146,HCPCS,Outpatient,,,5065.98,2532.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2314.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2314.3,2314.3,
"INSERT/PLACE HEART CATHETER",P960002023,CDM,960,RC,93503,HCPCS,Outpatient,,,214.78,107.39,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",72.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",72.87,72.87,
"Insertion of Catheter Artery",P960002024,CDM,960,RC,36620,HCPCS,Outpatient,,,108.48,54.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",38.1,38.1,
"Insertion of Cannula",P960002025,CDM,960,RC,36800,HCPCS,Outpatient,,,296.93,148.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",104.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",104.64,104.64,
"Tracheobronchoscopy est trach",P960002026,CDM,960,RC,31615,HCPCS,Outpatient,,,425.48,212.74,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",152.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",152.78,152.78,
"Bronchoscopy w FB removal",P960002027,CDM,960,RC,31635,HCPCS,Outpatient,,,729.15,364.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",254.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",254.55,254.55,
"Exploration of Hip jnt rmv fb",P960002028,CDM,960,RC,27033,HCPCS,Outpatient,,,2346.98,1173.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",842.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",842.46,842.46,
"Penis straightening chordee",P960002029,CDM,960,RC,54300,HCPCS,Outpatient,,,1566.48,783.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",554.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",554.45,554.45,
"Induced abort vag supp",P960002030,CDM,960,RC,59855,HCPCS,Outpatient,,,1011.15,505.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",281.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",281.37,281.37,
"Initial I/P pedi Critical Care",P960002031,CDM,960,RC,99471,HCPCS,Outpatient,,,1923.55,961.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",563.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",563.81,563.81,
"Subsq I/P Pedi Critical Care",P960002032,CDM,960,RC,99472,HCPCS,Outpatient,,,978.53,489.265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",284.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",284.79,284.79,
"Skin Full graft Face/Genit/HF",P960002033,CDM,960,RC,15240,HCPCS,Outpatient,,,1916.38,958.19,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",839.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",839.23,839.23,
"PTCA during acute MI",P960002034,CDM,960,RC,92941,HCPCS,Outpatient,,,1561.63,780.815,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",776.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,599.85,599.85,599.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",776.14,776.14,
"Bx/exc lymph nd Open deep axil",P960002035,CDM,960,RC,38525,HCPCS,Outpatient,,,1060.48,530.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",367.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",367.41,367.41,
"Incision drain pil cyst compl",P960002036,CDM,960,RC,10081,HCPCS,Outpatient,,,861.63,430.815,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",273.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,162.60,162.60,162.60,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,267.90,267.90,267.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",273.09,273.09,
"EGD GUIDE WIRE INSERTION",P960002038,CDM,960,RC,43248,HCPCS,Outpatient,,,1050.88,525.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",420.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,739.19,739.19,739.19,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,188.58,188.58,188.58,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",420.94,420.94,
"LYSIS OF ADHESIONS SALPINX/OVA",P960002039,CDM,960,RC,58740,HCPCS,Outpatient,,,2189.58,1094.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",765.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",765.61,765.61,
"EXC FOOT/TOE TUM SC 1.5 CM/>",P960002040,CDM,960,RC,28039,HCPCS,Outpatient,,,1197.4,598.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",431.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",431.76,431.76,
"INCISION OF ACHILLES TENDON",P960002041,CDM,960,RC,27605,HCPCS,Outpatient,,,819.83,409.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",296.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",296.58,296.58,
"REMOVE RENAL TUBE W/FLUORO",P960002042,CDM,960,RC,50389,HCPCS,Outpatient,,,1073.5,536.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",308.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",308.51,308.51,
"Placement Seton",P960002044,CDM,960,RC,46020,HCPCS,Outpatient,,,278.9,139.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",278.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2206.30,2206.30,2206.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",278.9,278.9,
"COLONOSCOPY W/BAND LIGATION",P960002045,CDM,960,RC,45398,HCPCS,Outpatient,,,2123.8,1061.9,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",847.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",847.33,847.33,
"ED Level 1 Ltd/Minor",P960002046,CDM,960,RC,99281,HCPCS,Outpatient,,,53.15,26.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,69.42,69.42,73.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,76.06,62.14,146.86,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,53.13,24.79,81.47,"1 through 10",other,"not separately reimbursment",,,,23.08,23.08,23.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",15.95,15.95,
"Ed Level 2 Low/Mod",P960002047,CDM,960,RC,99282,HCPCS,Outpatient,,,102.88,51.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30.69,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,34.73,34.73,34.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.26,48.26,48.26,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.84,81.20,159.25,30,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,186.47,106.11,301.59,150,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,159.25,70.08,159.25,"1 through 10",other,"not separately reimbursment",,,,156.07,96.80,364.21,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",30.69,30.69,
"ED Level 3 Moderate",P960002048,CDM,960,RC,99283,HCPCS,Outpatient,,,174.78,87.39,,,,,,,,0,other,"not separately reimbursement",,,,581.40,247.66,581.40,17,other,"not separately reimbursement",45.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,598.65,157.49,901.89,"1 through 10",other,"not separately reimbursment",,,,165.08,154.79,240.54,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,688.50,688.50,688.50,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,150.38,147.08,186.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,218.30,183.45,278.45,602,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,210.04,169.01,301.59,893,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,278.45,278.45,278.45,65,other,"not separately reimbursment",,,,352.59,146.07,673.20,32,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.98,45.98,
"ED Level 4 High/Urgent",P960002049,CDM,960,RC,99284,HCPCS,Outpatient,,,295.83,147.915,,,,,,,,0,other,"not separately reimbursement",,,,763.04,419.67,953.80,33,other,"not separately reimbursement",84.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1120.46,726.72,1459.32,"1 through 10",other,"not separately reimbursment",,,,398.67,317.46,417.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,903.60,752.35,982.67,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,311.86,150.38,419.38,15,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,335.72,297.30,428.22,911,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,645.39,511.89,1287.25,344,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,428.22,428.22,428.22,125,other,"not separately reimbursment",,,,468.02,297.16,955.31,28,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.24,84.24,
"Remove Aortic Assist Device",P960002050,CDM,960,RC,33968,HCPCS,Outpatient,,,78.77,39.385,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",28.48,28.48,
"Drain Neck/Chest Lesion",P960002051,CDM,960,RC,21501,HCPCS,Outpatient,,,808.1,404.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",402.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.18,402.18,
"ED Lvl 5 High Sevrty & Threat",P960002052,CDM,960,RC,99285,HCPCS,Outpatient,,,429.25,214.625,,,,,,,,0,other,"not separately reimbursement",,,,1342.20,1285.69,1398.71,"1 through 10",other,"not separately reimbursement",122.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,833.70,429.87,1237.52,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,489.08,483.20,494.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,483.38,457.42,616.56,51,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,979.10,758.24,2597.40,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,616.56,616.56,616.56,"1 through 10",other,"not separately reimbursment",,,,540.53,493.49,591.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",122.36,122.36,
"ORCHIOPEXY INGUN/SCROT APPR",P960002054,CDM,960,RC,54640,HCPCS,Outpatient,,,1045.65,522.825,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",373.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",373.28,373.28,
"DRAIN NECK/CHEST LESION",P960002055,CDM,960,RC,21501,HCPCS,Outpatient,,,808.1,404.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",402.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",402.18,402.18,
"INS ENDOVAS VENA CAVA FILTR",P960002056,CDM,960,RC,37191,HCPCS,Outpatient,,,529.05,264.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",529.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4262.00,4262.00,4262.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",529.05,529.05,
"Treatment of ankle fracture",P960002057,CDM,960,RC,27823,HCPCS,Outpatient,,,2397.98,1198.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",847.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",847.57,847.57,
"Exc leg/ankle les sc 3cm/>",P960002058,CDM,960,RC,27632,HCPCS,Outpatient,,,996.2,498.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",357.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",357.26,357.26,
"LARYNGOSCOPY W/FB REMOVAL",P960002059,CDM,960,RC,31530,HCPCS,Outpatient,,,479.3,239.65,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",179.01,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",179.01,179.01,
"CAPILLARY BLOOD DRAW",P960002060,CDM,960,RC,36416,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1.77,1.77,
"EXC S/N/H/F/G MAL+MRG 3.1-4",P960002061,CDM,960,RC,11624,HCPCS,Outpatient,,,825.1,412.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",304.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,63.12,63.12,63.12,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,250.53,250.53,250.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",304.95,304.95,
"TTE W/O DOPPLER COMPLETE",P960002062,CDM,960,RC,93307,HCPCS,Outpatient,,,108.88,54.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",108.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.88,108.88,
"CARDIOVASCULAR STRESS TEST",P960002063,CDM,960,RC,93016,HCPCS,Outpatient,,,53.15,26.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",18.12,18.12,
"EXC RECT TUM TRANSANAL FULL",P960002065,CDM,960,RC,45172,HCPCS,Outpatient,,,2007.75,1003.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",892.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",892.8,892.8,
"INT HRHC LIG 2+HROID W/O IMG",P960002066,CDM,960,RC,46946,HCPCS,Outpatient,,,940.13,470.065,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",412.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,485.46,485.46,485.46,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",412.06,412.06,
"DECOMPRESS FOREARM 1 SPACE",P960002067,CDM,960,RC,25020,HCPCS,Outpatient,,,1849.45,924.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",550.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",550.66,550.66,
"EXPLORE LIMB VESSELS",P960002068,CDM,960,RC,35860,HCPCS,Outpatient,,,1977.63,988.815,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",702.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",702.7,702.7,
"TREAT LOWER LEG FRACTURE",P960002069,CDM,960,RC,27825,HCPCS,Outpatient,,,1196.25,598.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",471.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",471.27,471.27,
"TREAT FINGER FRACTURE EACH",P960002070,CDM,960,RC,26746,HCPCS,Outpatient,,,1804.88,902.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",641.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",641.85,641.85,
"TREAT FRACTURE RADIUS/ULNA",P960002071,CDM,960,RC,25600,HCPCS,Outpatient,,,798.73,399.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",284.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",284.99,284.99,
"DRAIN HAND TENDON SHEATH",P960002072,CDM,960,RC,26020,HCPCS,Outpatient,,,1355.6,677.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",478.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",478.86,478.86,
"CYSTECTOMY COMPLETE SEPARATE P",P960002073,CDM,960,RC,51570,HCPCS,Outpatient,,,3545.03,1772.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1244.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1244.21,1244.21,
"TREAT FX RAD INTRA-ARTICUL",P960002074,CDM,960,RC,25608,HCPCS,Outpatient,,,2005.95,1002.975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",713.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",713.19,713.19,
"Inject Skin lesions up to 7",P960002075,CDM,960,RC,11900,HCPCS,Outpatient,,,139.23,69.615,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",49.43,49.43,
"Exc Shldr Tumor Deep < 5cm",P960002076,CDM,960,RC,23076,HCPCS,Outpatient,,,1314.7,657.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",467.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",467.42,467.42,
"Treatment of Tibia Fracture",P960002077,CDM,960,RC,27752,HCPCS,Outpatient,,,1310.25,655.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",461.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",461.82,461.82,
"EXPLORE ABDOMINAL VESSELS",P960002078,CDM,960,RC,35840,HCPCS,Outpatient,,,2876.3,1438.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1009.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1909.65,1909.65,1909.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1009.14,1009.14,
"ATTEMPTED VBAC DELIVERY ONLY",P960002079,CDM,960,RC,59620,HCPCS,Outpatient,,,2203.38,1101.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",632.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",632.86,632.86,
"Correction Hallux Valgus",P960002080,CDM,960,RC,28297,HCPCS,Outpatient,,,2545.35,1272.675,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",912.74,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",912.74,912.74,
"Skin Biopsy, single lesion",P960002081,CDM,960,RC,11106,HCPCS,Outpatient,,,387.9,193.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",136.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,482.62,482.62,482.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",136.54,136.54,
"Skin Biopsy, addtl lesions",P960002082,CDM,960,RC,11107,HCPCS,Outpatient,,,176.68,88.34,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",64.52,64.52,
"Partial removal of foot fascia",P960002083,CDM,960,RC,28060,HCPCS,Outpatient,,,1274.15,637.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",455.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3262.94,3262.94,3262.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",455.34,455.34,
"Repair webbed toe(s)",P960002084,CDM,960,RC,28345,HCPCS,Outpatient,,,1768.48,884.24,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",454.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",454.83,454.83,
"Treatment of toe fracture",P960002085,CDM,960,RC,28515,HCPCS,Outpatient,,,401.03,200.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",140.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",140.89,140.89,
"Remote 30 day ECG",P960002086,CDM,960,RC,93229,HCPCS,Outpatient,,,2173.9,1086.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",552.42,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",552.42,552.42,
"Tx Contour Defect 5.1-10cc",P960002087,CDM,960,RC,11952,HCPCS,Outpatient,,,347.78,173.89,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",129.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",129.99,129.99,
"DTAP-IPV-HIB-HEPB VACCINE IM",P960002088,CDM,960,RC,90697,HCPCS,Outpatient,,,165,82.5,,,,,,,,0,other,"not separately reimbursement",,,,165.00,165.00,165.00,"1 through 10",other,"not separately reimbursement",147.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,165.00,165.00,165.00,39,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,165.00,161.43,165.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,165.00,115.50,165.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",147.85,147.85,
"Coronary Art/Graft Angio",P960002089,CDM,960,RC,93455,HCPCS,Outpatient,,,660.73,330.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",660.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",660.73,660.73,
"Prolong OP/Off visit Medicare",P960002090,CDM,960,RC,,,Outpatient,,,77.6,38.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",77.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",77.6,77.6,
"Prolong OP E/M Each 15 min",P960002091,CDM,960,RC,99417,HCPCS,Outpatient,,,77.6,38.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,29.94,28.48,47.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.3,23.3,
"Colostomy, partial, ileocolost",P960002093,CDM,960,RC,44160,HCPCS,Outpatient,,,2977.83,1488.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1361.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1361.54,1361.54,
"Drain Open Retroperi Abscess",P960002094,CDM,960,RC,49060,HCPCS,Outpatient,,,2638.9,1319.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1207.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1207.11,1207.11,
"EXC FOREARM TUM DEEP < 3 CM",P96000243,CDM,960,RC,25076,HCPCS,Outpatient,,,1257.23,628.615,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",447.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",447.27,447.27,
"Pro Fee UMC Moore",P960003000,CDM,960,RC,55250,HCPCS,Outpatient,,,346.41,173.205,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",305.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,531.43,531.43,531.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",305.23,305.23,
"Alcohol/Sub Interv 15-30 min",P960003001,CDM,960,RC,,,Outpatient,,,86.85,43.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",86.85,86.85,
"Removal of Anal Tags",P960003002,CDM,960,RC,46230,HCPCS,Outpatient,,,418.93,209.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",319.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2757.88,2757.88,2757.88,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",319.18,319.18,
"Pericardiocentesis w imaging",P960003003,CDM,960,RC,33016,HCPCS,Outpatient,,,556.4,278.2,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",198.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",198.89,198.89,
"Dilate Esophagus 1/multipass",P960003004,CDM,960,RC,43450,HCPCS,Outpatient,,,472.28,236.14,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",185.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,471.43,471.43,471.43,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",185.29,185.29,
"Bx Vaginal mucosa simple",P960003005,CDM,960,RC,57100,HCPCS,Outpatient,,,254.38,127.19,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",81.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",81.52,81.52,
"Rmvl foreign body deep thigh",P960003006,CDM,960,RC,27372,HCPCS,Outpatient,,,1460.75,730.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",516.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",516.51,516.51,
"FTH/GFT FREE W/DIR CLOS S/A/L",P960003007,CDM,960,RC,15220,HCPCS,Outpatient,,,1872.23,936.115,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",694.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",694.37,694.37,
"RCNSTJ POLYDACTYLOUS Dgt Sof",P960003008,CDM,960,RC,26587,HCPCS,Outpatient,,,2524.75,1262.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",900.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",900.05,900.05,
"LHC w Ventriculography",P960003009,CDM,960,RC,93452,HCPCS,Outpatient,,,562.5,281.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",562.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",562.5,562.5,
"Arthroscopy Knee w/ Menisc Rpr",P960003010,CDM,960,RC,29882,HCPCS,Outpatient,,,1668.63,834.315,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",598.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,853.60,655.18,1052.02,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",598.97,598.97,
"Cardiovascular Proc, unlisted",P960003011,CDM,960,RC,93799,HCPCS,Outpatient,,,336.9,168.45,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",336.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",336.9,336.9,
"Reconstruction, toe",P960003012,CDM,960,RC,28344,HCPCS,Outpatient,,,1026.6,513.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",371.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",371.45,371.45,
"Arthroscopy, knee, diagnostic",P960003013,CDM,960,RC,29870,HCPCS,Outpatient,,,1352.53,676.265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",492.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",492.13,492.13,
"Correct Malrotation of Bowel",P960003014,CDM,960,RC,44055,HCPCS,Outpatient,,,3561.78,1780.89,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1633.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1633.55,1633.55,
"OB Visit New Level 2",P960003015,CDM,960,RC,99202,HCPCS,Outpatient,,,177.55,88.775,,,,,,,,0,other,"not separately reimbursement",,,,26.81,26.81,26.81,"1 through 10",other,"not separately reimbursement",52.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,63.98,21.24,69.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,37.63,25.29,49.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,59.44,47.72,67.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,48.29,41.09,48.29,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,98.50,55.70,141.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.9,52.9,
"OB Visit New Level 3",P960003016,CDM,960,RC,99203,HCPCS,Outpatient,,,272.6,136.3,,,,,,,,0,other,"not separately reimbursement",,,,62.93,40.23,89.12,14,other,"not separately reimbursement",75.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,70.30,21.27,101.17,93,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.05,63.35,82.95,15,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,83.99,67.45,105.80,371,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,60.03,51.08,65.25,120,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,27,other,"not separately reimbursment",,,,97.97,68.52,141.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.02,75.02,
"OB Visit New Level 4",P960003017,CDM,960,RC,99204,HCPCS,Outpatient,,,407.28,203.64,,,,,,,,0,other,"not separately reimbursement",,,,100.33,100.33,100.33,"1 through 10",other,"not separately reimbursement",114.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,128.54,88.73,154.01,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,155.73,126.15,155.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,123.21,68.40,162.76,50,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,95.47,81.24,111.31,27,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,192.52,"1 through 10",other,"not separately reimbursment",,,,211.08,152.79,265.25,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",114.84,114.84,
"OB Visit New Level 5",P960003018,CDM,960,RC,99205,HCPCS,Outpatient,,,538.75,269.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",145.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,200.46,192.96,211.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,124.55,124.55,124.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,121.69,34.45,150.81,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.70,109.85,118.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",145.23,145.23,
"OB Visit Estab Level 2",P960003019,CDM,960,RC,99212,HCPCS,Outpatient,,,137.63,68.815,,,,,,,,0,other,"not separately reimbursement",,,,34.51,33.33,42.13,"1 through 10",other,"not separately reimbursement",31.56,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,19.48,7.03,45.03,41,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.79,5.58,46.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.22,31.78,162.76,81,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,22.59,20.78,26.54,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,64.87,152.00,"1 through 10",other,"not separately reimbursment",,,,51.54,38.02,263.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",31.56,31.56,
"OB Visit Est Level 3",P960003020,CDM,960,RC,99213,HCPCS,Outpatient,,,221.63,110.815,,,,,,,,0,other,"not separately reimbursement",,,,50.92,30.92,75.69,53,other,"not separately reimbursement",52.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,45.85,17.39,70.85,189,other,"not separately reimbursment",,,,72.64,23.42,78.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,65.01,33.74,74.46,17,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,86.10,54.35,162.76,1044,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.71,31.23,39.90,328,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,105,other,"not separately reimbursment",,,,69.29,37.71,266.75,33,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",52.28,52.28,
"OB Visit Est Level 4",P960003021,CDM,960,RC,99214,HCPCS,Outpatient,,,313.45,156.725,,,,,,,,0,other,"not separately reimbursement",,,,75.23,46.26,131.60,23,other,"not separately reimbursement",75.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,73.73,25.28,103.73,119,other,"not separately reimbursment",,,,101.34,101.34,101.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,88.30,75.53,99.21,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,135.02,81.08,162.76,669,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,47.68,43.87,56.03,64,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,152.00,152.00,69,other,"not separately reimbursment",,,,127.59,60.32,266.75,19,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",75.99,75.99,
"OB Visit Est Level 5",P960003022,CDM,960,RC,99215,HCPCS,Outpatient,,,441.23,220.615,,,,,,,,0,other,"not separately reimbursement",,,,142.35,141.42,144.68,"1 through 10",other,"not separately reimbursement",102.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,113.98,29.05,138.94,34,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,118.95,106.93,130.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,113.89,97.45,140.65,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,73.40,61.10,97.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",102.18,102.18,
"Wedging cast",P960003023,CDM,960,RC,29740,HCPCS,Outpatient,,,236.58,118.29,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",84.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",84.39,84.39,
"Vag Hysterectomy",P960003024,CDM,960,RC,58260,HCPCS,Outpatient,,,2047.15,1023.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",715.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4334.28,4334.28,4334.28,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",715.77,715.77,
"NS CATH ABD/L-EXT ART 3RD",P960003025,CDM,960,RC,36247,HCPCS,Outpatient,,,3633.6,1816.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1257.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1257.63,1257.63,
"EXC THIGH/KNEE LES SC 3 CM/>",P960003026,CDM,960,RC,27337,HCPCS,Outpatient,,,1013.47,506.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",361.53,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",361.53,361.53,
"ARTHRSCPY KNEE W/MENISC REPAIR",P960003027,CDM,960,RC,29883,HCPCS,Outpatient,,,2032.5,1016.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",727.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",727.62,727.62,
"DRAINAGE OF PALMAR BURSA SINGL",P960003028,CDM,960,RC,26025,HCPCS,Outpatient,,,1025.73,512.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",363.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",363.44,363.44,
"LAP ING HERNIA REPAIR INIT",P960003029,CDM,960,RC,49650,HCPCS,Outpatient,,,1044.33,522.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",470.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,586.65,586.65,586.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4599.96,4599.96,4599.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,5867.31,5867.31,5867.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",470.03,470.03,
"Skin Full Graft Trunk",P960003030,CDM,960,RC,15200,HCPCS,Outpatient,,,1617.57,808.785,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",754.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",754.26,754.26,
"SURG DX EXAM ANORECTAL",P960003031,CDM,960,RC,45990,HCPCS,Outpatient,,,253.17,126.585,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",116.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",116.57,116.57,
"REMOVAL OF STOMACH PARTIAL",P960003032,CDM,960,RC,43633,HCPCS,Outpatient,,,4596.05,2298.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2109.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2109.16,2109.16,
"LAPARO-VAG HYST INCL T/O",P960003033,CDM,960,RC,58552,HCPCS,Outpatient,,,2384.02,1192.01,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",843.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",843.31,843.31,
"Durolane Inj 1 mg",P960003034,CDM,960,RC,,,Outpatient,,,23.15,11.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",23.15,23.15,
"REMOVAL OF TOE LESIONS",P960003035,CDM,960,RC,28092,HCPCS,Outpatient,,,1024.22,512.11,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",368.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",368.59,368.59,
"FUSION OF BIG TOE JOINT",P960003036,CDM,960,RC,28755,HCPCS,Outpatient,,,1241.7,620.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",443.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",443.64,443.64,
"INITIAL PREVENTIVE EXAM",P960003037,CDM,960,RC,,,Outpatient,,,312.55,156.275,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",312.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",312.55,312.55,
"RPR AA HERNIA 1ST<3cM REDUCIBL",P960003038,CDM,960,RC,49591,HCPCS,Outpatient,,,802.62,401.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",802.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,460.30,460.30,460.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,258.16,258.16,258.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.62,802.62,
"RPR AA HERNIA 1ST 3-10CM REDUC",P960003039,CDM,960,RC,49593,HCPCS,Outpatient,,,1344.52,672.26,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1344.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,1329.78,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,481.35,481.35,481.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1344.52,1344.52,
"RPR AA HERNIA 1ST >10CM REDUCB",P960003040,CDM,960,RC,49595,HCPCS,Outpatient,,,1808.62,904.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1808.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,4919.59,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1808.62,1808.62,
"RPR AA HERN 1ST 3CM NCRC8/STRN",P960003041,CDM,960,RC,49592,HCPCS,Outpatient,,,1116.32,558.16,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1116.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,640.35,526.90,697.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1116.32,1116.32,
"RPR AA HERN 1ST 3-10CM NCRC8",P960003042,CDM,960,RC,49594,HCPCS,Outpatient,,,1750.75,875.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1750.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,527.55,527.55,527.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,277.80,277.80,277.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1073.62,692.02,1455.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,5867.31,5867.31,5867.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1750.75,1750.75,
"RPR AA HERNIA 1ST>10 CM NCRC8",P960003043,CDM,960,RC,49596,HCPCS,Outpatient,,,2402.37,1201.185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2402.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2402.37,2402.37,
"RPR AA HERNIA RECR <3CM REDUCB",P960003044,CDM,960,RC,49613,HCPCS,Outpatient,,,989.7,494.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",989.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.7,989.7,
"RPR AA HERN RECR 3-10CM REDUCB",P960003045,CDM,960,RC,49615,HCPCS,Outpatient,,,1501,750.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1501,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,860.57,860.57,860.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1501,1501,
"RPR AA HERNIA RECR >10CM REDUC",P960003046,CDM,960,RC,49617,HCPCS,Outpatient,,,2077.9,1038.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2077.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,168.78,168.78,168.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,513.13,513.13,513.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2077.9,2077.9,
"RPR AA HERNIA RECR <3CM NCRC8",P960003047,CDM,960,RC,49614,HCPCS,Outpatient,,,1341.32,670.66,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1341.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1341.32,1341.32,
"RPR AA HERN RECR 3-10CM NCRC8",P960003048,CDM,960,RC,49616,HCPCS,Outpatient,,,2015.47,1007.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2015.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1359.64,1359.64,1359.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2015.47,2015.47,
"RPR AA HERN RECR >10CM NCRC8",P960003049,CDM,960,RC,49618,HCPCS,Outpatient,,,2910.67,1455.335,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2910.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2910.67,2910.67,
"IMPL ABSRB MSH/PRSTH DLY CLS",P960003050,CDM,960,RC,15778,HCPCS,Outpatient,,,902.77,451.385,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",902.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",902.77,902.77,
"NURSING FAC CARE SUBSEQ 45 min",P960003051,CDM,960,RC,99310,HCPCS,Outpatient,,,364.27,182.135,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",94.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.83,94.83,
"RPR S/N/A/GEN/TRK12.6-20.0CM",P960003052,CDM,960,RC,12005,HCPCS,Outpatient,,,419.22,209.61,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",153.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",153.33,153.33,
"CPRIT CA Screen; Pelvic/breast",P960003053,CDM,960,RC,,,Outpatient,,,98.18,49.09,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",98.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.18,98.18,
"80 RPR AA HERNIA 1ST<3VM REDUC",P960003054,CDM,960,RC,49591,HCPCS,Outpatient,,,802.62,401.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",802.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,460.30,460.30,460.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,258.16,258.16,258.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.62,802.62,
"20RPR AA HERNIA 1ST <3CM REDUC",P960003055,CDM,960,RC,49591,HCPCS,Outpatient,,,802.62,401.31,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",802.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,460.30,460.30,460.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,258.16,258.16,258.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",802.62,802.62,
"80RPR AA HERNIA 1ST 3-10CM RED",P960003056,CDM,960,RC,49593,HCPCS,Outpatient,,,1344.52,672.26,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1344.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,1329.78,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,481.35,481.35,481.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1344.52,1344.52,
"20RPR AA HERNIA 1ST 3-10CM RED",P960003057,CDM,960,RC,49593,HCPCS,Outpatient,,,1344.52,672.26,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1344.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,1329.78,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,481.35,481.35,481.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1344.52,1344.52,
"80 RPR AA HERNIA 1ST>10CM RED",P960003058,CDM,960,RC,49595,HCPCS,Outpatient,,,1808.62,904.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1808.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,4919.59,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1808.62,1808.62,
"20 RPR AA HERNIA 1ST>10CM RED",P960003059,CDM,960,RC,49595,HCPCS,Outpatient,,,1808.62,904.31,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1808.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4919.59,4919.59,4919.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1255.00,1255.00,1255.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1808.62,1808.62,
"80 RPR AA HERNIA 1ST<3CM NCRC8",P960003060,CDM,960,RC,49592,HCPCS,Outpatient,,,1116.32,558.16,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1116.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,640.35,526.90,697.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1116.32,1116.32,
"20 RPR AA HERNIA 1ST<3 CM NCRC",P960003061,CDM,960,RC,49592,HCPCS,Outpatient,,,1116.32,558.16,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1116.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,640.35,526.90,697.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1116.32,1116.32,
"80RPR AA HERNIA 1ST 3-10CM NCR",P960003062,CDM,960,RC,49594,HCPCS,Outpatient,,,1750.75,875.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1750.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,527.55,527.55,527.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,277.80,277.80,277.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1073.62,692.02,1455.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,5867.31,5867.31,5867.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1750.75,1750.75,
"20RPR AA HERNIA 1ST3-10CM NCRC",P960003063,CDM,960,RC,49594,HCPCS,Outpatient,,,1750.75,875.375,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1750.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,527.55,527.55,527.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,277.80,277.80,277.80,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1073.62,692.02,1455.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,5867.31,5867.31,5867.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1750.75,1750.75,
"80RPR AA HERNIA 1ST>10 CM NCRC",P960003064,CDM,960,RC,49596,HCPCS,Outpatient,,,2402.37,1201.185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2402.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2402.37,2402.37,
"20 RPR AA HERNIA 1ST>10CM NCRC",P960003065,CDM,960,RC,49596,HCPCS,Outpatient,,,2402.37,1201.185,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2402.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2402.37,2402.37,
"80 RPR AA HERNIA RECR<3 CM RED",P960003066,CDM,960,RC,49613,HCPCS,Outpatient,,,989.7,494.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",989.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.7,989.7,
"20 RPR AA HERNIA RECR <3CM RED",P960003067,CDM,960,RC,49613,HCPCS,Outpatient,,,989.7,494.85,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",989.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.7,989.7,
"80RPR AA HERNIA RECR 3-10CM RE",P960003068,CDM,960,RC,49615,HCPCS,Outpatient,,,1501,750.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1501,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,860.57,860.57,860.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1501,1501,
"20RPR AA HERNIA RECR 3-10CM RE",P960003069,CDM,960,RC,49615,HCPCS,Outpatient,,,1501,750.5,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1501,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,860.57,860.57,860.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1501,1501,
"80RPR AA HERNIA RECR>10 CM RED",P960003070,CDM,960,RC,49617,HCPCS,Outpatient,,,2077.9,1038.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2077.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,168.78,168.78,168.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,513.13,513.13,513.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2077.9,2077.9,
"20 RPR AA HERNIA RECR>10CM RED",P960003071,CDM,960,RC,49617,HCPCS,Outpatient,,,2077.9,1038.95,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2077.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,168.78,168.78,168.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,513.13,513.13,513.13,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2077.9,2077.9,
"80RPR AA HERNIA RECR<3CM NCRC8",P960003072,CDM,960,RC,49614,HCPCS,Outpatient,,,1341.32,670.66,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1341.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1341.32,1341.32,
"20RPR AA HERNIA RECR<3CM NCRC8",P960003073,CDM,960,RC,49614,HCPCS,Outpatient,,,1341.32,670.66,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1341.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1341.32,1341.32,
"80RPR AA HERNIA RECR 3-10CM NC",P960003074,CDM,960,RC,49616,HCPCS,Outpatient,,,2015.47,1007.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2015.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1359.64,1359.64,1359.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2015.47,2015.47,
"20RPR AA HERNIA RECR 3-10CM NC",P960003075,CDM,960,RC,49616,HCPCS,Outpatient,,,2015.47,1007.735,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2015.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1359.64,1359.64,1359.64,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2015.47,2015.47,
"80 RPR AA HERNIA RECR >10CM NC",P960003076,CDM,960,RC,49618,HCPCS,Outpatient,,,2910.67,1455.335,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2910.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2910.67,2910.67,
"20 RPR AA HERNIA RECR>10CM NCR",P960003077,CDM,960,RC,49618,HCPCS,Outpatient,,,2910.67,1455.335,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2910.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2910.67,2910.67,
"Repair of Corporeal Tear",P960003078,CDM,960,RC,54437,HCPCS,Outpatient,,,1640.37,820.185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",579.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",579.72,579.72,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Hosp IP/OBS care same date Mod",P960003079,CDM,960,RC,99235,HCPCS,Outpatient,,,389.07,194.535,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,131.92,131.92,131.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.50,122.13,146.87,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.17,36.17,36.17,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.3,119.3,
"Gastrectomy,partial,distal",P960003080,CDM,960,RC,43632,HCPCS,Outpatient,,,4890.12,2445.06,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2230.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2230.27,2230.27,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"VAGOTOMY PFRMD W/PRTL DSTL GST",P960003081,CDM,960,RC,43635,HCPCS,Outpatient,,,269.27,134.635,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",123.58,123.58,
"PRCRD DRG 6YR+ W/O CGEN CAR",P960003082,CDM,960,RC,33017,HCPCS,Outpatient,,,583.18,291.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",206.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",206.68,206.68,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"INTRO NDL ICATH UPR/LXTR ART",P960003083,CDM,960,RC,36140,HCPCS,Outpatient,,,211.05,105.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",211.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",211.05,211.05,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"MECH REMOV TUNNELED CV CATH",P960003085,CDM,960,RC,36595,HCPCS,Outpatient,,,434.15,217.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",434.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",434.15,434.15,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"R&L HRT ART/VENTRICLE ANGIO",P960003086,CDM,960,RC,93461,HCPCS,Outpatient,,,975.58,487.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",975.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2318.63,2318.63,2318.63,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",975.58,975.58,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"HEART FLOW RESERVE MEASURE",P960003087,CDM,960,RC,93572,HCPCS,Outpatient,,,124.3,62.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",90.43,90.43,
"CHRNC CARE MGMT PHYS 1ST 30",P960003088,CDM,960,RC,99491,HCPCS,Outpatient,,,206.75,103.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.24,58.24,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM Staff Each addtl 20 min",P960003089,CDM,960,RC,99439,HCPCS,Outpatient,,,115,57.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25.93,25.93,
"CCM RHC Clinical Staff 20min",P960003090,CDM,960,RC,,,Outpatient,,,194.85,97.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",194.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.85,194.85,
"CCM RHC Clinical Staff 20min",P960003090,CDM,960,RC,,,Outpatient,,,194.85,97.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",194.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.85,194.85,
"CCM RHC Clinical Staff 20min",P960003090,CDM,960,RC,,,Outpatient,,,194.85,97.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",194.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.85,194.85,
"CCM RHC Clinical Staff 20min",P960003090,CDM,960,RC,,,Outpatient,,,194.85,97.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",194.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.85,194.85,
"CCM RHC Clinical Staff 20min",P960003090,CDM,960,RC,,,Outpatient,,,194.85,97.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",194.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",194.85,194.85,
"Induced abortion by D & C",P960003091,CDM,960,RC,59840,HCPCS,Outpatient,,,606.62,303.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",157.58,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",157.58,157.58,
"INSJ SUBQ CAR RHYTHM MNTR",P960003092,CDM,960,RC,33285,HCPCS,Outpatient,,,209.71,104.855,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",209.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",209.71,209.71,
"PRQ CARDIAC ANGIO ADDL ART",P960003093,CDM,960,RC,92920,HCPCS,Outpatient,,,622.7,311.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",620.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,98.04,98.04,98.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,384.34,384.34,384.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",620.85,620.85,
"ENDOLUMINL IVUS OCT C EA ADDTL",P960003094,CDM,960,RC,92979,HCPCS,Outpatient,,,178.95,89.475,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",133.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,14.00,14.00,14.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,54.90,54.90,54.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.08,133.08,
"ENDOLUMINL IVUS OCT C EA ADDTL",P960003094,CDM,960,RC,92979,HCPCS,Outpatient,,,178.95,89.475,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",133.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,14.00,14.00,14.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,54.90,54.90,54.90,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",133.08,133.08,
"TAP BLOCK BILATERAL BY INJECT",P960003095,CDM,960,RC,64488,HCPCS,Outpatient,,,167.4,83.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",115.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,54.08,54.08,54.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",115.8,115.8,
"SURG ARTHROSCOPY SHOULDER PRT",P960003096,CDM,960,RC,29820,HCPCS,Outpatient,,,1303.5,651.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",464.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",464.14,464.14,
"80 Decompression of lower leg",P960003097,CDM,960,RC,27602,HCPCS,Outpatient,,,1149.1,574.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",418.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",418.45,418.45,
"20 Decompression of lower leg",P960003098,CDM,960,RC,27602,HCPCS,Outpatient,,,1149.1,574.55,80,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",418.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",418.45,418.45,
"ARTHRT EXPL DRG/RMVL LOOSE/FB",P960003099,CDM,960,RC,26080,HCPCS,Outpatient,,,981.1,490.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",339.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",339.49,339.49,
"LAP ENTERECTOMY",P960003100,CDM,960,RC,44202,HCPCS,Outpatient,,,3337.55,1668.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1518.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1518.78,1518.78,
"LAP ENTERECTOMY",P960003100,CDM,960,RC,44202,HCPCS,Outpatient,,,3337.55,1668.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1518.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1518.78,1518.78,
"LAPAR COLECTOMY PART W/ANASTOM",P960003101,CDM,960,RC,44204,HCPCS,Outpatient,,,3692.72,1846.36,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1687.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1196.67,1196.67,1196.67,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1687.28,1687.28,
"LAP MOBIL SPLENIC FL ADD-ON",P960003102,CDM,960,RC,44213,HCPCS,Outpatient,,,445.5,222.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",205.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",205.6,205.6,
"Part. Excision Phalanx of toe",P960003103,CDM,960,RC,28124,HCPCS,Outpatient,,,813.25,406.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",417.72,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,448.11,448.11,448.11,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,322.35,322.35,322.35,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",417.72,417.72,
"INT HRHC LIG 1 HROID W/O IMG",P960003104,CDM,960,RC,46945,HCPCS,Outpatient,,,826.2,413.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",365.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,317.76,317.76,317.76,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,324.24,324.24,324.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.77,78.77,78.77,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",365.02,365.02,
"EXC FACE-MM B9+MARG >4 CM",P960003105,CDM,960,RC,11446,HCPCS,Outpatient,,,767.15,383.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",352.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",352.15,352.15,
"REMOVE ANAL FIST COMPLEX",P960003106,CDM,960,RC,46280,HCPCS,Outpatient,,,1172.07,586.035,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",520.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",520.3,520.3,
"LAP COLECTOMY PART W/ILEUM",P960003107,CDM,960,RC,44205,HCPCS,Outpatient,,,3209.7,1604.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1466.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1466.7,1466.7,
"Prevnar 20 IM",P960003108,CDM,636,RC,90677,HCPCS,Outpatient,,,721.65,360.825,,721.65,125,,,,,0,"fee schedule","125% of CMS fee schedule",548.45,76,,329.37,329.37,329.37,"1 through 10","percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",519.59,72,,415.67,,,0,"percent of total billed charges","72% of total billed charges",541.24,75,,321.28,306.03,321.28,43,"percent of total billed charges","75% of total billed charges",721.65,100,,,,,0,"fee schedule","100% of CMS fee schedule",519.59,72,,415.67,,,0,"percent of total billed charges","72% of total billed charges",432.99,60,,346.39,,,0,"percent of total billed charges","60% of total billed charges",649.49,90,,519.59,,,0,"percent of total billed charges","90% of total billed charges",324.74,45,,259.79,,,0,"percent of total billed charges","45% of total billed charges",649.49,90,,519.59,,,0,"percent of total billed charges","90% of total billed charges",721.65,100,,312.90,312.90,312.90,"1 through 10","fee schedule","100% of CMS fee schedule",721.65,100,,,,,0,"fee schedule","100% CMS fee schedule",721.65,100,,306.64,298.04,312.90,12,"fee schedule","100% of CMS fee schedule",469.07,65,,375.26,,,0,"percent of total billed charges","65% of total billed charges",318.25,27,,254.60,,,0,"percent of total billed charges","27% of total billed charges",685.57,95,,548.46,,,0,"percent of total billed charges","95% of total billed charges",721.65,75,,152.00,152.00,152.00,"1 through 10","fee schedule","75% of CMS fee schedule",635.05,88,,323.14,314.27,323.85,13,"percent of total billed charges","88% of total billed charges",649.49,90,,519.59,,,0,"percent of total billed charges","90% of total billed charges",318.25,721.65,
"SPLENECTOMY TOTAL SEPAR. PROCD",P960003109,CDM,960,RC,38100,HCPCS,Outpatient,,,2770.35,1385.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",971.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",971.8,971.8,
"SUTR LG INTEST 1/MULT PRF WO C",P960003110,CDM,960,RC,44604,HCPCS,Outpatient,,,2538.05,1269.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1159.6,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1159.6,1159.6,
"SIGMOIDOSCOPY W/PLCMT STENT",P960003111,CDM,960,RC,45347,HCPCS,Outpatient,,,369.47,184.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",170.36,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",170.36,170.36,
"EXC HAND TUM DEEP 1.5 CM/>",P960003112,CDM,960,RC,26113,HCPCS,Outpatient,,,1339.75,669.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",473.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",473.2,473.2,
"EXC ABDL TUM DEEP 5 CM/>",P960003113,CDM,960,RC,22901,HCPCS,Outpatient,,,1612.35,806.175,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",577,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",577,577,
"Ultrasonic guidnce, intraoper",P960003114,CDM,960,RC,76998,HCPCS,Outpatient,,,147.52,73.76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42.59,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",42.59,42.59,
"CMG; Patient prov sensor plcmt",P960003115,CDM,960,RC,95249,HCPCS,Outpatient,,,151.6,75.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",61.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",61.85,61.85,
"TREAT ECTOPIC PREGNANCY",P960003116,CDM,960,RC,59150,HCPCS,Outpatient,,,1915.55,957.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",524.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",524.25,524.25,
"Conization of cervix",P960003117,CDM,960,RC,57520,HCPCS,Outpatient,,,864.5,432.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",283.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",283.11,283.11,
"Vag Hysterectomy Uterus >250gm",P960003118,CDM,960,RC,58290,HCPCS,Outpatient,,,2811.2,1405.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",989.71,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",989.71,989.71,
"NTUBATION ENDOTRACHEAL EMERGEN",P960003119,CDM,960,RC,31500,HCPCS,Outpatient,,,341.38,170.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",130.28,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,120.69,120.69,120.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,183.08,183.08,183.08,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,244.37,139.95,348.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,233.53,233.53,233.53,"1 through 10",other,"not separately reimbursment",,,,440.69,440.69,440.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.28,130.28,
"Mastectomy Gynecomastia",P960003120,CDM,960,RC,19300,HCPCS,Outpatient,,,1051.93,525.965,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",495.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.93,495.93,
"LAP FULGURATION OVIDUCTS",P960003121,CDM,960,RC,58670,HCPCS,Outpatient,,,909.13,454.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",315.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",315.95,315.95,
"Rev Foreign Body simple",P960003122,CDM,960,RC,20520,HCPCS,Outpatient,,,357.8,178.9,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",181.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",181.34,181.34,
"Destruction, Malignant Lesion",P960003123,CDM,960,RC,17272,HCPCS,Outpatient,,,293.58,146.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",168.57,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",168.57,168.57,
"I&D BELW FASCIA FT 1 BURSA SPC",P960003124,CDM,960,RC,28002,HCPCS,Outpatient,,,341.77,170.885,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",341.77,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",341.77,341.77,
"Cath of umbilical vein,newborn",P960003125,CDM,960,RC,36510,HCPCS,Outpatient,,,129.67,64.835,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",69.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",69.7,69.7,
"V-Excision Lip w linear closur",P960003126,CDM,960,RC,40520,HCPCS,Outpatient,,,873.82,436.91,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",540.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",540.29,540.29,
"EGD DILATE STRICTURE",P960003127,CDM,960,RC,43245,HCPCS,Outpatient,,,421.37,210.685,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",421.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,70.59,70.59,70.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,129.74,78.50,1222.47,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,16.55,16.55,16.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",421.37,421.37,
"TREATMENT OF FOOT INFECTION",P960003128,CDM,960,RC,28003,HCPCS,Outpatient,,,926.12,463.06,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",611.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",611.44,611.44,
"NEG PRESS WOUND TX >50 CM",P960003129,CDM,960,RC,97608,HCPCS,Outpatient,,,885.62,442.81,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",384.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",384.87,384.87,
"TIS TRNFR S/A/L 10 SQ CM/<",P960003130,CDM,960,RC,14020,HCPCS,Outpatient,,,1370.2,685.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",625.97,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",625.97,625.97,
"LAPAROSCOPY ASPIRATION",P960003131,CDM,960,RC,49322,HCPCS,Outpatient,,,907.25,453.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",409.23,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",409.23,409.23,
"DESTRUCTION; MALIGNANT LESION",P960003132,CDM,960,RC,17261,HCPCS,Outpatient,,,210.07,105.035,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",130.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.78,130.78,
"Removal of sutures or staples",P960003133,CDM,960,RC,15853,HCPCS,Outpatient,,,27.2,13.6,,,,,,,,0,other,"not separately reimbursement",,,,11.06,10.60,11.52,"1 through 10",other,"not separately reimbursement",27.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,14.44,4.17,16.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,8.14,8.14,8.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,8.24,6.92,10.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,5.08,1.91,8.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.2,27.2,
"Removal of sutures and staples",P960003134,CDM,960,RC,15854,HCPCS,Outpatient,,,35.3,17.65,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",35.3,35.3,
"Removal of sutures or staples",P960003135,CDM,960,RC,15851,HCPCS,Outpatient,,,138.72,69.36,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",92.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",92.67,92.67,
"COLPORRHAPHY SUTURE INJ VAGINA",P960003136,CDM,960,RC,57200,HCPCS,Outpatient,,,3348,1674,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",270.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",270.9,270.9,
"CYSTOURETERO W/RENAL STRICT",P960003137,CDM,960,RC,52346,HCPCS,Outpatient,,,5271.22,2635.61,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",376.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",376.17,376.17,
"REMOVE ANAL FIST SUBQ",P960003138,CDM,960,RC,46270,HCPCS,Outpatient,,,2875.47,1437.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",569.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,351.66,351.66,351.66,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,384.39,384.39,384.39,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,480.91,480.91,480.91,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",569.41,569.41,
"SURG ARTHROSCPY SHLDR DSTL CLV",P960003140,CDM,960,RC,29824,HCPCS,Outpatient,,,1653.32,826.66,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",583.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",583.52,583.52,
"COLPOSCOPY VAGINA W/CERVIX",P960003143,CDM,960,RC,57420,HCPCS,Outpatient,,,216.82,108.41,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",106.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",106.48,106.48,
"PREPUTIAL STRETCHING",P960003144,CDM,960,RC,54450,HCPCS,Outpatient,,,137.7,68.85,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",58.9,58.9,
"Anterior Colporrhaphy",P960003145,CDM,960,RC,57240,HCPCS,Outpatient,,,1499.45,749.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",518.18,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",518.18,518.18,
"HIB Vaccine",P960003146,CDM,960,RC,90647,HCPCS,Outpatient,,,64.65,32.325,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,35.78,35.78,35.78,18,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,32.41,32.41,32.41,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,36.08,36.08,36.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",27.67,27.67,
"Pt Focused Hlth Risk Assmt",P960003147,CDM,960,RC,96160,HCPCS,Outpatient,,,6.45,3.225,,,,,,,,0,other,"not separately reimbursement",,,,3.20,3.20,3.20,"1 through 10",other,"not separately reimbursement",2.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,4.18,2.88,4.22,31,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2.83,2.83,2.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.19,3.91,5.23,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.83,2.83,
"Caregiver Health Risk Assmt",P960003148,CDM,960,RC,96161,HCPCS,Outpatient,,,6.45,3.225,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.83,2.83,
"Brief Emotional/Behvrl Assmt",P960003149,CDM,960,RC,96127,HCPCS,Outpatient,,,11.1,5.55,,,,,,,,0,other,"not separately reimbursement",,,,5.44,5.44,5.44,"1 through 10",other,"not separately reimbursement",5.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,7.31,4.99,7.39,23,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,6.34,4.83,6.34,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",5.54,5.54,
"Biopsy of Liver Wedge",P960003150,CDM,960,RC,47100,HCPCS,Outpatient,,,2049.43,1024.715,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",926.87,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",926.87,926.87,
"EXC SHOULDER LES SC < 3 CM",P960003151,CDM,960,RC,23075,HCPCS,Outpatient,,,1255.9,627.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",430.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",430.48,430.48,
"Arexvy(RSV)vacc; 0.5 mL",P960003152,CDM,960,RC,90679,HCPCS,Outpatient,,,659.75,329.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",659.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,327.60,327.60,340.70,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",659.75,659.75,
"PROCTOSIGMOIDOSCOPY ABLATE",P960003153,CDM,960,RC,45320,HCPCS,Outpatient,,,250.62,125.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",217.63,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.63,217.63,
"ADMN SARSCOV2 VACC 1 DOSE",P960003154,CDM,960,RC,90480,HCPCS,Outpatient,,,100,50,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",100,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100,100,
"SARSCOV2 VAC 3MCG TRS-SUC IM",P960003156,CDM,960,RC,91318,HCPCS,Outpatient,,,163.4,81.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",163.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",163.4,163.4,
"SARSCOV2 VAC 3MCG TRS-SUC IM",P960003156,CDM,960,RC,91318,HCPCS,Outpatient,,,163.4,81.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",163.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",163.4,163.4,
"SARSCV2 VAC 10MCG TRS-SUC IM",P960003157,CDM,960,RC,91319,HCPCS,Outpatient,,,219.45,109.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",219.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",219.45,219.45,
"SARSCV2 VAC 10MCG TRS-SUC IM",P960003157,CDM,960,RC,91319,HCPCS,Outpatient,,,219.45,109.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",219.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",219.45,219.45,
"SARSCV2 VAC 30MCG TRS-SUC IM",P960003158,CDM,960,RC,91320,HCPCS,Outpatient,,,327.75,163.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",327.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",327.75,327.75,
"SARSCV2 VAC 30MCG TRS-SUC IM",P960003158,CDM,960,RC,91320,HCPCS,Outpatient,,,327.75,163.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",327.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",327.75,327.75,
"SARSCOV2 VAC 25 MCG/.25ML IM",P960003159,CDM,960,RC,91321,HCPCS,Outpatient,,,364.8,182.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",364.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",364.8,364.8,
"SARSCOV2 VAC 25 MCG/.25ML IM",P960003159,CDM,960,RC,91321,HCPCS,Outpatient,,,364.8,182.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",364.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",364.8,364.8,
"SARSCOV2 VAC 50 MCG/0.5ML IM",P960003160,CDM,960,RC,91322,HCPCS,Outpatient,,,364.8,182.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",364.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",364.8,364.8,
"SARSCOV2 VAC 50 MCG/0.5ML IM",P960003160,CDM,960,RC,91322,HCPCS,Outpatient,,,364.8,182.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",364.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",364.8,364.8,
"PRQ CARD REVASC CHRONIC 1VSL",P960003161,CDM,960,RC,92943,HCPCS,Outpatient,,,1558.7,779.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",776.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",776.14,776.14,
"PRQ CARD REVASC CHRONIC 1VSL",P960003161,CDM,960,RC,92943,HCPCS,Outpatient,,,1558.7,779.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",776.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",776.14,776.14,
"Multiplex Test(Covid,RSV,Flu)",P960003162,CDM,960,RC,87637,HCPCS,Outpatient,,,356.57,178.285,,,,,,,,0,other,"not separately reimbursement",,,,141.98,104.63,271.00,15,other,"not separately reimbursement",121.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,117.63,92.63,142.63,73,other,"not separately reimbursment",,,,141.18,140.20,141.18,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.92,320.92,320.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,139.78,139.78,139.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,139.78,139.78,154.37,293,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,201.26,201.26,250.11,526,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,142.63,142.63,142.63,"1 through 10",other,"not separately reimbursment",,,,139.78,75.62,309.08,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",121.24,121.24,
"Multiplex Test(Covid,RSV,Flu)",P960003162,CDM,960,RC,87637,HCPCS,Outpatient,,,339,169.5,,,,,,,,0,other,"not separately reimbursement",,,,141.98,104.63,271.00,15,other,"not separately reimbursement",121.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,117.63,92.63,142.63,73,other,"not separately reimbursment",,,,141.18,140.20,141.18,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,320.92,320.92,320.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,139.78,139.78,139.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,139.78,139.78,154.37,293,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,201.26,201.26,250.11,526,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,142.63,142.63,142.63,"1 through 10",other,"not separately reimbursment",,,,139.78,75.62,309.08,22,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",121.24,121.24,
"LAP ING HERNIA REPAIR RECUR",P960003163,CDM,960,RC,49651,HCPCS,Outpatient,,,1368.42,684.21,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",612.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,429.55,429.55,429.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",612.24,612.24,
"LAP ING HERNIA REPAIR RECUR",P960003163,CDM,960,RC,49651,HCPCS,Outpatient,,,1368.42,684.21,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",612.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,429.55,429.55,429.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",612.24,612.24,
"PED CRIT CARE AGE 2-5 INIT",P960003164,CDM,960,RC,99475,HCPCS,Outpatient,,,1358.62,679.31,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",396.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",396.88,396.88,
"PED CRIT CARE AGE 2-5 SUBSQ",P960003165,CDM,960,RC,99476,HCPCS,Outpatient,,,818.87,409.435,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",245.11,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",245.11,245.11,
"PRQ CORONARY MECH THROMBECT",P960003166,CDM,960,RC,92973,HCPCS,Outpatient,,,412.5,206.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",142.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",142.46,142.46,
"REMOVAL OF URETHRA LESION",P960003167,CDM,960,RC,53230,HCPCS,Outpatient,,,1461.37,730.685,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",512.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",512.41,512.41,
"DESTROY INTERNAL HEMORRHOIDS",P960003168,CDM,960,RC,46930,HCPCS,Outpatient,,,361.35,180.675,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",232.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",232.27,232.27,
"NJX CAR CTH SPRVLV AORTGRPHY",P960003169,CDM,960,RC,93567,HCPCS,Outpatient,,,88.1,44.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",88.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",88.1,88.1,
"Orphenadrine Inj 30mg",P960003170,CDM,960,RC,,,Outpatient,,,24.25,12.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.25,24.25,
"DILATION OF ANAL SPHINCTER",P960003171,CDM,960,RC,45905,HCPCS,Outpatient,,,1435.32,717.66,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",184.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",184.31,184.31,
"Exc Back Tum Deep 5CM/>",P960003172,CDM,960,RC,21933,HCPCS,Outpatient,,,2713.2,1356.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",638.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,704.82,704.82,704.82,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",638.15,638.15,
"Unlisted Procedure intestine",P960003173,CDM,960,RC,44238,HCPCS,Outpatient,,,1500,750,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1500,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1500,1500,
"PERQ TRLUML CORONRY LITHOTRP",P960003174,CDM,960,RC,92972,HCPCS,Outpatient,,,343.25,171.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",343.25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",343.25,343.25,
"Mobilization of colon",P960003175,CDM,960,RC,44139,HCPCS,Outpatient,,,285,142.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",132.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",132.73,132.73,
"I&D ISCHIORCT/INTRAMURAL ABSC",P960003176,CDM,960,RC,46060,HCPCS,Outpatient,,,1166.32,583.16,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",526.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",526.99,526.99,
"LAP PART COLECTOMY W/STOMA",P960003177,CDM,960,RC,44206,HCPCS,Outpatient,,,4141.57,2070.785,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1917.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1917.22,1917.22,
"EXC SHOULDER TUM DEEP 5 CM/>",P960003178,CDM,960,RC,23073,HCPCS,Outpatient,,,1675.82,837.91,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",601.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",601.37,601.37,
"Methylprednisolone 40 mg",P960003179,CDM,960,RC,,,Outpatient,,,2.5,1.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.5,2.5,
"REPAIR BLOOD VESSEL LESION",P960003180,CDM,960,RC,35221,HCPCS,Outpatient,,,3537.57,1768.785,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1232.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1232.95,1232.95,
"DSTR MAL LES S/N/H/F/G 0.6-1",P960003181,CDM,960,RC,17271,HCPCS,Outpatient,,,243.47,121.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",147.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",147.49,147.49,
"SIGMOIDOSCOPY & POLYPECTOMY",P960003182,CDM,960,RC,45333,HCPCS,Outpatient,,,1111.52,555.76,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",337.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",337.89,337.89,
"REMOVE FOREIGN BODY ABDOMEN",P960003183,CDM,960,RC,49402,HCPCS,Outpatient,,,2080.87,1040.435,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",938.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",938.27,938.27,
"Sports Physical",P960003184,CDM,960,RC,99212,HCPCS,Outpatient,,,25,12.5,,,,,,,,0,other,"not separately reimbursement",,,,34.51,33.33,42.13,"1 through 10",other,"not separately reimbursement",25,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,19.48,7.03,45.03,41,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.79,5.58,46.92,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,42.22,31.78,162.76,81,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,22.59,20.78,26.54,26,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,152.00,64.87,152.00,"1 through 10",other,"not separately reimbursment",,,,51.54,38.02,263.75,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",25,25,
"ONDANSETRON, ORAL, 4MG",P960003185,CDM,960,RC,,,Outpatient,,,6.5,3.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6.5,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",6.5,6.5,
ILEOSTOMY/JEJUNOSTOMY,P960003186,CDM,960,RC,44310,HCPCS,Outpatient,,,2522.77,1261.385,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1142.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1142.66,1142.66,
"TETRACAINE 0.5% OPHTH SOLN",P960003187,CDM,960,RC,,,Outpatient,,,59.49,29.745,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",59.49,59.49,
"LAP ILEO/JEJUNO-STOMY",P960003188,CDM,960,RC,44187,HCPCS,Outpatient,,,2638.7,1319.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1204.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1204.78,1204.78,
"REMOVAL OF RECTAL MARKER",P960003189,CDM,960,RC,46030,HCPCS,Outpatient,,,210.25,105.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",156.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",156.38,156.38,
"MUSCLE-SKIN GRAFT TRUNK",P960003190,CDM,960,RC,15734,HCPCS,Outpatient,,,3640.37,1820.185,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1368.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1368.52,1368.52,
"CYSTO W/RENAL STRICTURE TX",P960003191,CDM,960,RC,52343,HCPCS,Outpatient,,,825.9,412.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",290.2,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",290.2,290.2,
"EXPLORE SMALL INTESTINE",P960003192,CDM,960,RC,44020,HCPCS,Outpatient,,,2366.95,1183.475,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1067.12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1067.12,1067.12,
"CYSTOSCOPY AND TREATMENT",P960003193,CDM,960,RC,52320,HCPCS,Outpatient,,,591.1,295.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",207.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",207.82,207.82,
"CYSTOSCOPY STONE REMOVAL",P960003194,CDM,960,RC,52325,HCPCS,Outpatient,,,768.27,384.135,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",269.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",269.76,269.76,
"EGD VARICES LIGATION",P960003195,CDM,960,RC,43244,HCPCS,Outpatient,,,587.47,293.735,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",271.86,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,45.73,45.73,45.73,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,181.51,181.51,181.51,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",271.86,271.86,
"LAPAROSCOPY LYMPH NODE BIOP",P960003196,CDM,960,RC,38570,HCPCS,Outpatient,,,1258.8,629.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",432.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",432.26,432.26,
"Dicyclomine 20 mg Inj",P960003197,CDM,960,RC,,,Outpatient,,,50.82,25.41,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",50.82,50.82,
"EGD Control Bleeding Any",P960003198,CDM,960,RC,43255,HCPCS,Outpatient,,,479.9,239.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",479.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",479.9,479.9,
"REMOVE ANAL FIST INTER",P960003199,CDM,960,RC,46275,HCPCS,Outpatient,,,1029.75,514.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",601.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,445.14,445.14,445.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",601.37,601.37,
"INJ, BUPIVACAINE, NOS, 0.5MG",P960003200,CDM,960,RC,,,Outpatient,,,12,6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",12,12,
Metatarsectomy,P960003201,CDM,960,RC,28140,HCPCS,Outpatient,,,1041.58,520.79,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",512.64,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",512.64,512.64,
"RELEASE OF BIG TOE",P960003202,CDM,960,RC,28240,HCPCS,Outpatient,,,1066.05,533.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",390.82,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",390.82,390.82,
"Phalangectomy, toe, each toe",P960003203,CDM,960,RC,28150,HCPCS,Outpatient,,,1006.73,503.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",367.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",367.14,367.14,
"COLONOSCOPY W/CONTROL BLEED",P960003204,CDM,960,RC,45382,HCPCS,Outpatient,,,1582.65,791.325,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",760.68,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",760.68,760.68,
"COLONOSCOPY W/FB  REMOVAL",P960003205,CDM,960,RC,45379,HCPCS,Outpatient,,,1042.25,521.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",462.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",462.67,462.67,
"REMOVE SHOULDER  FOREIGN BODY",P960003206,CDM,960,RC,23330,HCPCS,Outpatient,,,723.98,361.99,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",248.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",248.15,248.15,
"STRAPPING; ANKLE AND/OR FOOT",P960003207,CDM,960,RC,29540,HCPCS,Outpatient,,,67.83,33.915,,,,,,,,0,other,"not separately reimbursement",,,,27.74,27.74,27.74,"1 through 10",other,"not separately reimbursement",24.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,25.86,19.56,32.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,26.14,26.14,26.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,39.99,39.99,39.99,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,468.79,468.79,468.79,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",24.65,24.65,
"PROSTATE LASER ENUCLEATION",P960003208,CDM,960,RC,52649,HCPCS,Outpatient,,,2002.75,1001.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",695.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",695.67,695.67,
"REVISION OF SCROTUM",P960003209,CDM,960,RC,55175,HCPCS,Outpatient,,,891.25,445.625,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",311.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",311.21,311.21,
"PARTIAL REMOVAL OF FOOT BONE",P960003210,CDM,960,RC,28122,HCPCS,Outpatient,,,1076.2,538.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",519.39,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3262.94,3262.94,3262.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",519.39,519.39,
"FUSION OF BIG TOE JOINT",P960003211,CDM,960,RC,28750,HCPCS,Outpatient,,,1408.88,704.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",692.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3035.06,957.25,5112.86,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",692.92,692.92,
"INCISION OF TOE TENDON",P960003212,CDM,960,RC,28010,HCPCS,Outpatient,,,510.38,255.19,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",202.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,279.32,279.32,279.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",202.95,202.95,
"REMOVAL OF FALLOPIAN  TUBE",P960003213,CDM,960,RC,58700,HCPCS,Outpatient,,,1958.63,979.315,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",675.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",675.26,675.26,
"Fecal Occult Blood Test",P960003214,CDM,960,RC,82272,HCPCS,Outpatient,,,10.58,5.29,,,,,,,,0,other,"not separately reimbursement",,,,31.16,31.16,31.16,"1 through 10",other,"not separately reimbursement",2.73,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,2.96,2.84,2.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.15,4.15,4.15,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4.15,4.15,4.15,24,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7.42,5.89,7.42,36,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2.73,2.73,
"TREAT METACARPAL FRACTURE",P960003215,CDM,960,RC,26605,HCPCS,Outpatient,,,722.98,361.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",279.7,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",279.7,279.7,
"TREATMENT OF ANKLE FRACTURE",P960003216,CDM,960,RC,27788,HCPCS,Outpatient,,,960.18,480.09,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",366.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",366.05,366.05,
"LAP PARAESOPHAG HERN REPAIR",P960003217,CDM,960,RC,43281,HCPCS,Outpatient,,,3728.4,1864.2,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1691.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1670.78,1670.78,1670.78,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1425.04,1425.04,1425.04,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1140.03,1140.03,1140.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1691.44,1691.44,
"REMOVE VAGINA GLAND  LESION",P960003219,CDM,960,RC,56740,HCPCS,Outpatient,,,770.25,385.125,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",263.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",263.44,263.44,
"REMOVAL OF SESAMOID  BONE",P960003220,CDM,960,RC,28315,HCPCS,Outpatient,,,798.6,399.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",420.15,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,220.00,220.00,220.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",420.15,420.15,
"PARTIAL REMOVAL OF TOE",P960003221,CDM,960,RC,28160,HCPCS,Outpatient,,,654.43,327.215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",361.96,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2558.14,2558.14,2558.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",361.96,361.96,
"Commercial Beyfortus 0.5 mL",P960003222,CDM,960,RC,90380,HCPCS,Outpatient,,,1296,648,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1296,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,608.11,608.11,650.67,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1296,1296,
"Commercial Beyfortus 1 mL",P960003223,CDM,960,RC,90381,HCPCS,Outpatient,,,1296,648,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1296,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,650.67,608.11,650.67,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1296,1296,
"PRQ CARD REVASC CHRONIC ADDL",P960003224,CDM,960,RC,92944,HCPCS,Outpatient,,,1558.7,779.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",513.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",513.54,513.54,
"INCISION OF ACHILLES TENDON",P960003225,CDM,960,RC,27606,HCPCS,Outpatient,,,658.7,329.35,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",240.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",240.88,240.88,
"REVISION OF CALF TENDON",P960003226,CDM,960,RC,27687,HCPCS,Outpatient,,,1114.5,557.25,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",394.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",394.94,394.94,
"SHO ARTHRS SRG COMPL SYNVCT",P960003227,CDM,960,RC,29821,HCPCS,Outpatient,,,1452.6,726.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",512.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",512.62,512.62,
"TREAT METACARPAL FRACTURE",P960003228,CDM,960,RC,26600,HCPCS,Outpatient,,,720.8,360.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",254.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",254.8,254.8,
"KNEE ARTHROSCOPY/SURGERY",P960003229,CDM,960,RC,29876,HCPCS,Outpatient,,,1600.03,800.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",565.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,950.42,899.48,1001.36,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,3262.94,903.56,3262.94,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",565.08,565.08,
"PART REMOVAL OF METATARSA",P960003230,CDM,960,RC,28112,HCPCS,Outpatient,,,767.05,383.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",424.61,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2558.14,2558.14,2558.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",424.61,424.61,
"VAGINAL DELIVERY AFTER CESAREA",P960003231,CDM,960,RC,59612,HCPCS,Outpatient,,,2208.98,1104.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",610.95,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",610.95,610.95,
"REMOVE VAGINA WALL PARTIAL",P960003232,CDM,960,RC,57106,HCPCS,Outpatient,,,1313.5,656.75,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",440.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",440.05,440.05,
"REPAIR RECTUM & VAGINA",P960003233,CDM,960,RC,57250,HCPCS,Outpatient,,,1506.6,753.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",520.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",520.85,520.85,
"INSERT TUNNELED CV CATH",P960003234,CDM,960,RC,36558,HCPCS,Outpatient,,,620.45,310.225,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",620.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2712.85,2712.85,2712.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",620.45,620.45,
"DX BONE MARROW ASPIRATIONS",P960003238,CDM,960,RC,38220,HCPCS,Outpatient,,,376.6,188.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.1,139.1,
"REPAIR OF RUPTURED TENDON",P960003239,CDM,960,RC,24342,HCPCS,Outpatient,,,24342,12171,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",671.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1238.59,1238.59,1238.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",671.65,671.65,
"RMVL FB UPPER ARM/ELBW SUBQ",P960003240,CDM,960,RC,24200,HCPCS,Outpatient,,,24200,12100,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",186.03,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",186.03,186.03,
"TREAT METATARSAL FRACTURE",P960003241,CDM,960,RC,28476,HCPCS,Outpatient,,,947.88,473.94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",317.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",317.37,317.37,
"PART REMOVAL OF METATARSAL",P960003242,CDM,960,RC,28110,HCPCS,Outpatient,,,1112.03,556.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",403.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2555.37,2555.37,2555.37,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",403.33,403.33,
"EXC ARM/ELBOW LES SC 3 CM/>",P960003243,CDM,960,RC,24071,HCPCS,Outpatient,,,993.78,496.89,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",350.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",350.38,350.38,
"EXPLORE/TREAT FINGER JOINT",P960003244,CDM,960,RC,26075,HCPCS,Outpatient,,,822.2,411.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",289.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",289.48,289.48,
"TREATMENT OF HEEL FRACTURE",P960003245,CDM,960,RC,28405,HCPCS,Outpatient,,,1101.53,550.765,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",335.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",335.47,335.47,
"TREAT KNEE DISLOCATION",P960003246,CDM,960,RC,27552,HCPCS,Outpatient,,,1531.2,765.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",543.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",543.41,543.41,
"TREATMENT OF THIGH FRACTURE",P960003247,CDM,690,RC,27509,HCPCS,Outpatient,,,1617.37,808.685,,1617.37,125,,,,,0,"fee schedule","125% of CMS fee schedule",1229.2,76,,983.36,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",1164.51,72,,931.61,,,0,"percent of total billed charges","72% of total billed charges",1213.03,75,,970.42,,,0,"percent of total billed charges","75% of total billed charges",1617.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",1164.51,72,,931.61,,,0,"percent of total billed charges","72% of total billed charges",970.42,60,,776.34,,,0,"percent of total billed charges","60% of total billed charges",1455.63,90,,1164.50,,,0,"percent of total billed charges","90% of total billed charges",727.82,45,,582.26,,,0,"percent of total billed charges","45% of total billed charges",1455.63,90,,1164.50,,,0,"percent of total billed charges","90% of total billed charges",1617.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",1617.37,100,,,,,0,"fee schedule","100% CMS fee schedule",1617.37,100,,,,,0,"fee schedule","100% of CMS fee schedule",1051.29,65,,841.03,,,0,"percent of total billed charges","65% of total billed charges",713.26,27,,570.61,,,0,"percent of total billed charges","27% of total billed charges",1536.5,95,,1229.20,,,0,"percent of total billed charges","95% of total billed charges",1617.37,75,,,,,0,"fee schedule","75% of CMS fee schedule",1423.29,88,,1138.63,,,0,"percent of total billed charges","88% of total billed charges",1455.63,90,,1164.50,,,0,"percent of total billed charges","90% of total billed charges",713.26,1617.37,
"Excise anal ext tag/papilla",P960003249,CDM,960,RC,46220,HCPCS,Outpatient,,,577.75,288.875,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",247.52,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",247.52,247.52,
"EXC BACK LES SC < 3 CM",P960003250,CDM,960,RC,21930,HCPCS,Outpatient,,,1180.33,590.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",422.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",422.27,422.27,
"KNEE ARTHROSCOPY/SURGERY",P960003251,CDM,960,RC,29888,HCPCS,Outpatient,,,2323.15,1161.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",849.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1086.65,1086.65,1086.65,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,929.27,929.27,929.27,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",849.24,849.24,
"OSTEOCHONDRAL KNEE ALLOGRA",P960003252,CDM,960,RC,27415,HCPCS,Outpatient,,,3275.8,1637.9,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1188.26,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1188.26,1188.26,
"EXC ARM/ELBOW LES SC < 3  CM",P960003253,CDM,960,RC,24075,HCPCS,Outpatient,,,793.73,396.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",445.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",445.27,445.27,
"EXC BACK LES SC < 3 CM",P960003254,CDM,960,RC,21930,HCPCS,Outpatient,,,1180.33,590.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",422.27,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",422.27,422.27,
"TAP BLOCK UNIL BY INJECTION",P960003255,CDM,960,RC,64486,HCPCS,Outpatient,,,254.38,127.19,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",94.22,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",94.22,94.22,
"REPAIR BOWEL OPENING",P960003256,CDM,960,RC,44625,HCPCS,Outpatient,,,2388.55,1194.275,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1111.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1111.94,1111.94,
"Flublock Trivalent Influenza V",P960003257,CDM,960,RC,90673,HCPCS,Outpatient,,,207.73,103.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,85.83,85.83,85.83,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",36.34,36.34,
"PCV21 VACCINE IM",P960003258,CDM,636,RC,90684,HCPCS,Outpatient,,,819.73,409.865,,819.73,125,,,,,0,"fee schedule","125% of CMS fee schedule",622.99,76,,498.39,,,0,"percent of total billed charges","76% total billed charges",,,,,,,0,other,"not separately reimbursment",590.21,72,,472.17,,,0,"percent of total billed charges","72% of total billed charges",614.8,75,,336.67,330.85,336.67,"1 through 10","percent of total billed charges","75% of total billed charges",819.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",590.21,72,,472.17,,,0,"percent of total billed charges","72% of total billed charges",491.84,60,,393.47,,,0,"percent of total billed charges","60% of total billed charges",737.76,90,,590.21,,,0,"percent of total billed charges","90% of total billed charges",368.88,45,,295.10,,,0,"percent of total billed charges","45% of total billed charges",737.76,90,,590.21,,,0,"percent of total billed charges","90% of total billed charges",819.73,100,,,,,0,"fee schedule","100% of CMS fee schedule",819.73,100,,,,,0,"fee schedule","100% CMS fee schedule",819.73,100,,321.33,321.33,321.33,"1 through 10","fee schedule","100% of CMS fee schedule",532.82,65,,426.26,,,0,"percent of total billed charges","65% of total billed charges",361.5,27,,289.20,,,0,"percent of total billed charges","27% of total billed charges",778.74,95,,622.99,,,0,"percent of total billed charges","95% of total billed charges",819.73,75,,327.89,327.89,327.89,"1 through 10","fee schedule","75% of CMS fee schedule",721.36,88,,321.34,321.34,321.34,"1 through 10","percent of total billed charges","88% of total billed charges",737.76,90,,590.21,,,0,"percent of total billed charges","90% of total billed charges",361.5,819.73,
"RECONSTRUCTION KNEE",P960003259,CDM,960,RC,27428,HCPCS,Outpatient,,,2675.4,1337.7,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",964.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",964.48,964.48,
"BIOPSY LOWER LEG SOFT TISSUE",P960003260,CDM,960,RC,27613,HCPCS,Outpatient,,,589.6,294.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",217.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",217.48,217.48,
"PART REMOVAL OF METATARSAL",P960003261,CDM,960,RC,28113,HCPCS,Outpatient,,,1369.33,684.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",512.24,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,2558.14,2558.14,2558.14,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",512.24,512.24,
"PERITONEAL LAVAGE",P960003262,CDM,960,RC,49084,HCPCS,Outpatient,,,254.53,127.265,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",119.16,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,127.68,127.68,127.68,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",119.16,119.16,
"TREATMENT OF ANKLE FRACTURE",P960003263,CDM,960,RC,27810,HCPCS,Outpatient,,,1158.3,579.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",403.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",403.89,403.89,
"SIGMOIDOSCOPY W/SUBMUC INJ",P960003264,CDM,960,RC,45335,HCPCS,Outpatient,,,158.85,79.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",158.85,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",158.85,158.85,
"LAP RMVL GASTR ADJ ALL PARTS",P960003265,CDM,960,RC,43774,HCPCS,Outpatient,,,2290.33,1145.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1052.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,718.24,718.24,718.24,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1052.38,1052.38,
"FIXATION OF KNEE JOINT",P960003266,CDM,960,RC,27570,HCPCS,Outpatient,,,372.15,186.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",130.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",130.02,130.02,
"PARTIAL REMOVAL OF COLON",P960003267,CDM,960,RC,44144,HCPCS,Outpatient,,,4167.2,2083.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1937.34,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1937.34,1937.34,
"LAP REMOVAL OF RECTUM",P960003268,CDM,960,RC,45395,HCPCS,Outpatient,,,4596.75,2298.375,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2159.94,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1459.57,1459.57,1459.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",2159.94,2159.94,
"COLONOSCOPY W/STENT PLCMT",P960003269,CDM,960,RC,45389,HCPCS,Outpatient,,,675.38,337.69,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",321.02,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",321.02,321.02,
"KNEE ARTHROSCOPY/SURGERY",P960003270,CDM,960,RC,29875,HCPCS,Outpatient,,,1195.23,597.615,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",428.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",428.83,428.83,
"REPAIR OF HYDROCELE",P960003271,CDM,960,RC,55060,HCPCS,Outpatient,,,907,453.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",326.08,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",326.08,326.08,
"PARTIAL PROCTECTOMY",P960003272,CDM,960,RC,45123,HCPCS,Outpatient,,,2631.15,1315.575,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1225.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,835.44,835.44,835.44,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1225.65,1225.65,
"ADMN RSV MONOC ANTB  IM CNSL",P960003273,CDM,960,RC,96380,HCPCS,Outpatient,,,53.78,26.89,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",53.78,53.78,
"ADMN RSV MONOC ANTB  IM NJX",P960003274,CDM,960,RC,96381,HCPCS,Outpatient,,,45.83,22.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,40.00,34.60,40.00,12,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",45.83,45.83,
"TX SUPFC WND DEHSN  W/PACKING",P960003275,CDM,960,RC,12021,HCPCS,Outpatient,,,332.93,166.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",154.33,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",154.33,154.33,
"LAPARO ABLATE LIVER CRYOSURG",P960003276,CDM,960,RC,47371,HCPCS,Outpatient,,,2994,1497,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1377.06,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1377.06,1377.06,
"COR HLX VLGS PRX PHLX OSTEOT",P960003277,CDM,960,RC,28298,HCPCS,Outpatient,,,1214.33,607.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",733.47,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",733.47,733.47,
"INCISION OF METATARSAL",P960003278,CDM,960,RC,28308,HCPCS,Outpatient,,,930.88,465.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",495.75,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,11.96,11.96,11.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",495.75,495.75,
"SUSPENSION OF UTERUS",P960003279,CDM,960,RC,58400,HCPCS,Outpatient,,,1094.58,547.29,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",388.99,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",388.99,388.99,
"REPAIR OF NAIL BED",P960003280,CDM,960,RC,11760,HCPCS,Outpatient,,,429.68,214.84,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,85.00,85.00,85.00,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",139.51,139.51,
"UNLISTED LAPS PX STOMACH",P960003281,CDM,960,RC,43659,HCPCS,Outpatient,,,1301,650.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1301,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1301,1301,
"TREATMENT OF ANKLE FRACTURE",P960003282,CDM,960,RC,27818,HCPCS,Outpatient,,,1204.18,602.09,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",419.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,422.97,422.97,422.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",419.29,419.29,
"REPAIR/GRAFT KNEECAP TENDON",P960003283,CDM,960,RC,27381,HCPCS,Outpatient,,,1961,980.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",699.88,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,994.16,994.16,994.16,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",699.88,699.88,
"APPLY SHORT LEG CAST",P960003284,CDM,960,RC,29425,HCPCS,Outpatient,,,182.3,91.15,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",65.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",65.37,65.37,
"REMOVE VAGINAL FOREIGN BODY",P960003285,CDM,960,RC,57415,HCPCS,Outpatient,,,414.98,207.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",144.62,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1361.31,1361.31,1361.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.62,144.62,
"REVISION OF BIG TOE",P960003286,CDM,960,RC,28310,HCPCS,Outpatient,,,1282.1,641.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",476.78,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",476.78,476.78,
"EXC THIGH/KNEE LES SC < 3 CM",P960003287,CDM,960,RC,27327,HCPCS,Outpatient,,,1159.33,579.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",416.93,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,804.31,804.31,804.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",416.93,416.93,
"REVISION OF UNSTABLE KNEECAP",P960003288,CDM,960,RC,27422,HCPCS,Outpatient,,,8777.1,4388.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",643.66,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,7184.07,7184.07,7184.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",643.66,643.66,
"REPAIR SHOULDER CAPSULE",P960003289,CDM,960,RC,23455,HCPCS,Outpatient,,,11229.18,5614.59,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",861.43,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,4056.69,1554.79,6558.59,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",861.43,861.43,
"UNLISTED PROCEDURE, FOOT TOE",P960003290,CDM,960,RC,28899,HCPCS,Outpatient,,,67.83,33.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",67.83,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",67.83,67.83,
"LAPARO PARTIAL NEPHRECTOMY",P960003291,CDM,960,RC,50543,HCPCS,Outpatient,,,3521.13,1760.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1256.13,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,281.69,281.69,281.69,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1104.22,1104.22,1104.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1256.13,1256.13,
"EXPLORE/TREAT ANKLE JOINT",P960003292,CDM,960,RC,27610,HCPCS,Outpatient,,,1547.65,773.825,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",562.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",562.3,562.3,
"REMOVAL OF HEEL SPUR",P960003293,CDM,960,RC,28119,HCPCS,Outpatient,,,1227.05,613.525,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",457.05,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",457.05,457.05,
"KNEE ARTHROSCOPY/SURGERY",P960003294,CDM,960,RC,29884,HCPCS,Outpatient,,,1488.85,744.425,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",534.9,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",534.9,534.9,
"NCISION OF FOOT TENDON",P960003295,CDM,960,RC,28234,HCPCS,Outpatient,,,954.6,477.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",356.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,1609.45,1609.45,1609.45,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",356.46,356.46,
"XCISION OF RECTAL  PROLAPSE",P960003296,CDM,960,RC,45130,HCPCS,Outpatient,,,2563.88,1281.94,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1193.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,814.08,814.08,814.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1193.54,1193.54,
"PERQ TESTS W/ALRGNC  XTRCS",P960003297,CDM,960,RC,95004,HCPCS,Outpatient,,,8.43,4.215,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3.32,3.32,
"I & D OF VULVA/PERINEUM",P960003298,CDM,960,RC,56405,HCPCS,Outpatient,,,341.1,170.55,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",108.65,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",108.65,108.65,
"FUSION OF FOOT BONES",P960003299,CDM,960,RC,28740,HCPCS,Outpatient,,,1931.55,965.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",729.51,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",729.51,729.51,
"UNLISTED LAPS PX LIVE",P960003300,CDM,960,RC,47379,HCPCS,Outpatient,,,3327.55,1663.775,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3327.55,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",3327.55,3327.55,
"RABIES VACCINE IM",P960003301,CDM,960,RC,90675,HCPCS,Outpatient,,,780.05,390.025,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",368.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,312.03,249.06,316.07,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,372.03,302.16,408.55,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,312.03,312.03,312.03,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",368.21,368.21,
"REVISION OF TOE",P960003302,CDM,960,RC,28312,HCPCS,Outpatient,,,1304.1,652.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",437.44,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",437.44,437.44,
"BIOPSY OF VULVA/PERINEUM",P960003303,CDM,960,RC,56606,HCPCS,Outpatient,,,88.73,44.365,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32.76,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",32.76,32.76,
"DX BONE MARROW BX &  ASPIR",P960003304,CDM,960,RC,38222,HCPCS,Outpatient,,,405.95,202.975,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",144.98,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,34.49,34.49,34.49,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",144.98,144.98,
"LAPAROSCOPY  FUNDOPLASTY",P960003305,CDM,960,RC,43280,HCPCS,Outpatient,,,2559.33,1279.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1183.14,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,1055.88,962.02,1149.74,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9819.62,9819.62,9819.62,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,9718.57,9718.57,9718.57,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,134.22,134.22,134.22,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1183.14,1183.14,
"REVISE STOMACH-BOWEL FUSION",P960003306,CDM,960,RC,43865,HCPCS,Outpatient,,,4055.9,2027.95,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1874.29,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1874.29,1874.29,
Pyloroplasty,P960003307,CDM,960,RC,43800,HCPCS,Outpatient,,,2211.83,1105.915,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1021.91,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,506.53,506.53,506.53,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1021.91,1021.91,
"Sodium Bicarb 8.4 %",P960003308,CDM,960,RC,,,Outpatient,,,57.45,28.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.45,57.45,
"Heparin Sodium Per 1000 units",P960003309,CDM,960,RC,,,Outpatient,,,57.45,28.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",57.45,57.45,
"DRAINAGE OF HYDROCELE",P960003310,CDM,960,RC,55000,HCPCS,Outpatient,,,281.33,140.665,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",100.38,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,89.33,89.33,89.33,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",100.38,100.38,
"NJX AA&/STRD OTHER PN/BRANCH",P960003311,CDM,960,RC,64450,HCPCS,Outpatient,,,172.93,86.465,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,101.08,101.08,101.08,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",64.48,64.48,
"TREAT FINGER  DISLOCATION",P960003312,CDM,960,RC,26770,HCPCS,Outpatient,,,715.73,357.865,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",242.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",242.17,242.17,
"SIMPLE REPAIR F/E/E/N/L/M 2.5C",P960003313,CDM,960,RC,12011,HCPCS,Outpatient,,,262.1,131.05,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",98.92,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,195.69,159.16,284.90,18,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,518.32,518.32,518.32,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",98.92,98.92,
"SPLT AGRFT T/A/L EA ADDL  100",P960003314,CDM,960,RC,15101,HCPCS,Outpatient,,,429.13,214.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",169.46,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",169.46,169.46,
"COLONOSCOPY  W/RESECTION",P960003315,CDM,960,RC,45390,HCPCS,Outpatient,,,775.13,387.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",368.48,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",368.48,368.48,
"TREAT ELBOW  DISLOCATION",P960003319,CDM,960,RC,24640,HCPCS,Outpatient,,,244.68,122.34,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",87.84,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,87.85,87.85,87.85,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",87.84,87.84,
"SIGMOIDOSCOPY &  DECOMPRESS",P960003320,CDM,960,RC,45337,HCPCS,Outpatient,,,268.15,134.075,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",127.81,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,84.09,84.09,84.09,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",127.81,127.81,
"TREAT FINGER FRACTURE  EACH",P960003321,CDM,960,RC,26725,HCPCS,Outpatient,,,840.98,420.49,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",292.37,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,294.31,294.31,294.31,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",292.37,292.37,
"PRE4000US Prevena PLS 7 day Sy",P960003322,CDM,960,RC,,,Outpatient,,,1222.8,611.4,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1222.8,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1222.8,1222.8,
"PRE4095 Prevena Plus 150ml Can",P960003323,CDM,960,RC,,,Outpatient,,,91.89,45.945,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",91.89,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",91.89,91.89,
"PRE4055US Prevena Customizable",P960003324,CDM,960,RC,,,Outpatient,,,1339.45,669.725,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1339.45,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1339.45,1339.45,
"RPR F/E/E/N/L/M 2.6-5.0  CM",P960003325,CDM,960,RC,12013,HCPCS,Outpatient,,,137.43,68.715,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",103.32,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,92.97,92.97,92.97,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,286.11,286.11,286.11,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",103.32,103.32,
"Strep A PCR",P960003326,CDM,960,RC,87651,HCPCS,Outpatient,,,87.73,43.865,QW,,,,,,,0,other,"not separately reimbursement",,,,66.67,60.00,66.67,"1 through 10",other,"not separately reimbursement",22.67,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,19.30,18.14,19.30,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,78.96,78.96,78.96,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,28.48,28.48,28.48,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,49.51,49.51,49.51,424,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,61.76,35.17,77.20,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",22.67,22.67,
"L COLECTOMY/COLOPROCTOSTOMY",P960003327,CDM,960,RC,44207,HCPCS,Outpatient,,,4265.3,2132.65,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1994.19,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1994.19,1994.19,
"SHO ARTHRS SRG CAPSULORRAPHY",P960003328,CDM,960,RC,29806,HCPCS,Outpatient,,,2526.88,1263.44,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",915.54,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",915.54,915.54,
"REMOVAL OF BONE FOR GRAFT",P960003329,CDM,960,RC,20900,HCPCS,Outpatient,,,884.08,442.04,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",349.17,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",349.17,349.17,
"UPPR GI SCOPE W/SUBMUC INJ",P960003330,CDM,960,RC,43236,HCPCS,Outpatient,,,907.53,453.765,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",404.49,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",404.49,404.49,
"LAP CLOSE ENTEROSTOMY",P960003331,CDM,960,RC,44227,HCPCS,Outpatient,,,3909.13,1954.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1825.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1825.41,1825.41,
"INCISION OF FOOT FASCIA",P960003332,CDM,960,RC,28008,HCPCS,Outpatient,,,998.2,499.1,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",378.3,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",378.3,378.3,
"LAP CLOSE ENTEROSTOMY",P960003333,CDM,960,RC,44227,HCPCS,Outpatient,,,3909.13,1954.565,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1825.41,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",1825.41,1825.41,
"REPAIR OF KNEECAP TENDON",P960003334,CDM,960,RC,27380,HCPCS,Outpatient,,,1457.6,728.8,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",525.31,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",525.31,525.31,
"LIGATION&DIV LONG SAPH VEIN",P960003335,CDM,960,RC,37700,HCPCS,Outpatient,,,574.03,287.015,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",204.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",204.79,204.79,
"REMOVE IN/EX HEM GRPS & FISS",P960003336,CDM,960,RC,46261,HCPCS,Outpatient,,,1271.2,635.6,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",575.4,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",575.4,575.4,
"SHO ARTHRS SRG BICP TENODSIS",P960003337,CDM,960,RC,29828,HCPCS,Outpatient,,,2188.33,1094.165,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",795.1,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",795.1,795.1,
"PCV15 VACCINE IM COMM",P960003338,CDM,960,RC,90671,HCPCS,Outpatient,,,575,287.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",575,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,0.01,0.01,0.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,0.01,0.01,0.01,"1 through 10",other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",575,575,
"REVISION OF LOWER LEG  TENDON",P960003339,CDM,960,RC,27685,HCPCS,Outpatient,,,1076.6,538.3,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",573.09,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",573.09,573.09,
"INCISION OF METATARSAL",P960003340,CDM,960,RC,28306,HCPCS,Outpatient,,,937.03,468.515,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",527.21,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",527.21,527.21,
"ARTHROSC KNEE, FR INF/LAVAGE",P96000771,CDM,960,RC,29871,HCPCS,Outpatient,,,1009,504.5,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",443.79,85,,,,,0,"fee schedule","85% of AETNA fee schedule",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",443.79,443.79,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC",1,CDM,100,RC,,,Inpatient,,,,,,267871.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",214297.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",195169.7,100,,,,,0,"case rate","100% of CMS IPPS rate",214297.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",172863.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",172863.79,267871.39,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC",2,CDM,100,RC,,,Inpatient,,,,,,112852.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90282.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",65160.96,100,,,,,0,"case rate","100% of CMS IPPS rate",90282.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",57713.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57713.72,112852.61,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,CDM,100,RC,,,Inpatient,,,,,,204732.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",163785.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",148493.13,100,,,,,0,"case rate","100% of CMS IPPS rate",163785.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",131521.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",131521.87,204732.16,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,CDM,100,RC,,,Inpatient,,,,,,136252.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",109001.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",97902.53,100,,,,,0,"case rate","100% of CMS IPPS rate",109001.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",86713.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86713.27,136252.04,
"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT",5,CDM,100,RC,,,Inpatient,,,,,,103367.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",82694.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73786.5,100,,,,,0,"case rate","100% of CMS IPPS rate",82694.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",65353.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",65353.45,103367.85,
"LIVER TRANSPLANT WITHOUT MCC",6,CDM,100,RC,,,Inpatient,,,,,,50678.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40542.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33598.65,100,,,,,0,"case rate","100% of CMS IPPS rate",40542.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29758.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29758.67,50678.3,
"LUNG TRANSPLANT",7,CDM,100,RC,,,Inpatient,,,,,,127882.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",102306.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90549.79,100,,,,,0,"case rate","100% of CMS IPPS rate",102306.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",80200.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80200.87,127882.61,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT",8,CDM,100,RC,,,Inpatient,,,,,,59664.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47731.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37699.75,100,,,,,0,"case rate","100% of CMS IPPS rate",47731.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33391.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33391.05,59664.36,
"PANCREAS TRANSPLANT",10,CDM,100,RC,,,Inpatient,,,,,,74255.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59404.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",55242.53,100,,,,,0,"case rate","100% of CMS IPPS rate",59404.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48928.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48928.87,74255.11,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,CDM,100,RC,,,Inpatient,,,,,,58266.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46613.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37386.57,100,,,,,0,"case rate","100% of CMS IPPS rate",46613.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33113.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33113.67,58266.69,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,CDM,100,RC,,,Inpatient,,,,,,46768.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37414.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28433.31,100,,,,,0,"case rate","100% of CMS IPPS rate",37414.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25183.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25183.67,46768.51,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,CDM,100,RC,,,Inpatient,,,,,,34377.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27502.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18361.06,100,,,,,0,"case rate","100% of CMS IPPS rate",27502.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16262.57,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16262.57,34377.84,
"ALLOGENEIC BONE MARROW TRANSPLANT",14,CDM,100,RC,,,Inpatient,,,,,,119224.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",95379.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90778.44,100,,,,,0,"case rate","100% of CMS IPPS rate",95379.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",80403.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80403.39,119224.4,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC",16,CDM,100,RC,,,Inpatient,,,,,,62683.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50146.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41820.94,100,,,,,0,"case rate","100% of CMS IPPS rate",50146.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37041.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37041.23,62683.55,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC",17,CDM,100,RC,,,Inpatient,,,,,,58064.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46451.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41820.94,100,,,,,0,"case rate","100% of CMS IPPS rate",46451.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37041.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37041.23,58064.21,
"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES",18,CDM,100,RC,,,Inpatient,,,,,,408651.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",326921.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",261300.68,100,,,,,0,"case rate","100% of CMS IPPS rate",326921.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",231436.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",231436.67,408651.41,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS",19,CDM,100,RC,,,Inpatient,,,,,,73873.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59098.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54925.88,100,,,,,0,"case rate","100% of CMS IPPS rate",59098.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",48648.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48648.41,73873.4,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC",20,CDM,100,RC,,,Inpatient,,,,,,80691.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64553.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",55852.94,100,,,,,0,"case rate","100% of CMS IPPS rate",64553.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",49469.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49469.52,80691.89,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC",21,CDM,100,RC,,,Inpatient,,,,,,56777.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45422.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37005.49,100,,,,,0,"case rate","100% of CMS IPPS rate",45422.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32776.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32776.14,56777.98,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC",22,CDM,100,RC,,,Inpatient,,,,,,37123.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29698.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19137.07,100,,,,,0,"case rate","100% of CMS IPPS rate",29698.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16949.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16949.9,37123.08,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR",23,CDM,100,RC,,,Inpatient,,,,,,60831.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48665.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39528.93,100,,,,,0,"case rate","100% of CMS IPPS rate",48665.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35011.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35011.17,60831.74,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC",24,CDM,100,RC,,,Inpatient,,,,,,43944.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35155.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26340.84,100,,,,,0,"case rate","100% of CMS IPPS rate",35155.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23330.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23330.35,43944.33,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC",25,CDM,100,RC,,,Inpatient,,,,,,49839.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39871.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30987.23,100,,,,,0,"case rate","100% of CMS IPPS rate",39871.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27445.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27445.7,49839.7,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC",26,CDM,100,RC,,,Inpatient,,,,,,36489.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29191.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21192.12,100,,,,,0,"case rate","100% of CMS IPPS rate",29191.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18770.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18770.08,36489.7,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC",27,CDM,100,RC,,,Inpatient,,,,,,31044.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24835.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17098.65,100,,,,,0,"case rate","100% of CMS IPPS rate",24835.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15144.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15144.44,31044.76,
"SPINAL PROCEDURES WITH MCC",28,CDM,100,RC,,,Inpatient,,,,,,63413.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50730.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42123.03,100,,,,,0,"case rate","100% of CMS IPPS rate",50730.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37308.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37308.8,63413.5,
"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS",29,CDM,100,RC,,,Inpatient,,,,,,39298.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31438.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23257.57,100,,,,,0,"case rate","100% of CMS IPPS rate",31438.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20599.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20599.46,39298.09,
"SPINAL PROCEDURES WITHOUT CC/MCC",30,CDM,100,RC,,,Inpatient,,,,,,28001.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22401.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15419.13,100,,,,,0,"case rate","100% of CMS IPPS rate",22401.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13656.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13656.88,28001.41,
"VENTRICULAR SHUNT PROCEDURES WITH MCC",31,CDM,100,RC,,,Inpatient,,,,,,49224.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39379.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29035.41,100,,,,,0,"case rate","100% of CMS IPPS rate",39379.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25716.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25716.96,49224.91,
"VENTRICULAR SHUNT PROCEDURES WITH CC",32,CDM,100,RC,,,Inpatient,,,,,,27405.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21924.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14796.93,100,,,,,0,"case rate","100% of CMS IPPS rate",21924.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13105.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13105.79,27405.2,
"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC",33,CDM,100,RC,,,Inpatient,,,,,,23057.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18446.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11054.74,100,,,,,0,"case rate","100% of CMS IPPS rate",18446.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9791.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9791.3,23057.98,
"CAROTID ARTERY STENT PROCEDURES WITH MCC",34,CDM,100,RC,,,Inpatient,,,,,,43561.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34849.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26943.64,100,,,,,0,"case rate","100% of CMS IPPS rate",34849.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23864.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23864.25,43561.71,
"CAROTID ARTERY STENT PROCEDURES WITH CC",35,CDM,100,RC,,,Inpatient,,,,,,29815.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23852.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15761.41,100,,,,,0,"case rate","100% of CMS IPPS rate",23852.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13960.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13960.04,29815.18,
"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC",36,CDM,100,RC,,,Inpatient,,,,,,25657.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20525.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12701,100,,,,,0,"case rate","100% of CMS IPPS rate",20525.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11249.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11249.4,25657.4,
"EXTRACRANIAL PROCEDURES WITH MCC",37,CDM,100,RC,,,Inpatient,,,,,,38188.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30550.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23009.52,100,,,,,0,"case rate","100% of CMS IPPS rate",30550.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20379.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20379.77,38188.28,
"EXTRACRANIAL PROCEDURES WITH CC",38,CDM,100,RC,,,Inpatient,,,,,,22683.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18146.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11164.21,100,,,,,0,"case rate","100% of CMS IPPS rate",18146.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9888.26,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9888.26,22683.71,
"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC",39,CDM,100,RC,,,Inpatient,,,,,,18531.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14825.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7886.25,100,,,,,0,"case rate","100% of CMS IPPS rate",14825.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6984.93,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6984.93,18531.53,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,CDM,100,RC,,,Inpatient,,,,,,43473.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34778.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26135.75,100,,,,,0,"case rate","100% of CMS IPPS rate",34778.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23148.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23148.7,43473.49,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,CDM,100,RC,,,Inpatient,,,,,,28033.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22427.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15646.39,100,,,,,0,"case rate","100% of CMS IPPS rate",22427.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13858.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13858.17,28033.93,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,CDM,100,RC,,,Inpatient,,,,,,23659.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18927.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12177.88,100,,,,,0,"case rate","100% of CMS IPPS rate",18927.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10786.07,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10786.07,23659.79,
"SPINAL DISORDERS AND INJURIES WITH CC/MCC",52,CDM,100,RC,,,Inpatient,,,,,,24436.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19548.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13944.01,100,,,,,0,"case rate","100% of CMS IPPS rate",19548.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12350.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12350.35,24436.16,
"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC",53,CDM,100,RC,,,Inpatient,,,,,,16708.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13366.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6384.1,100,,,,,0,"case rate","100% of CMS IPPS rate",13366.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5654.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5654.47,16708.48,
"NERVOUS SYSTEM NEOPLASMS WITH MCC",54,CDM,100,RC,,,Inpatient,,,,,,21794.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17435.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10386.81,100,,,,,0,"case rate","100% of CMS IPPS rate",17435.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9199.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9199.71,21794.95,
"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC",55,CDM,100,RC,,,Inpatient,,,,,,17083.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13666.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7559.21,100,,,,,0,"case rate","100% of CMS IPPS rate",13666.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6695.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6695.27,17083.68,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC",56,CDM,100,RC,,,Inpatient,,,,,,29189.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23351.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17350.16,100,,,,,0,"case rate","100% of CMS IPPS rate",23351.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15367.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15367.21,29189.23,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC",57,CDM,100,RC,,,Inpatient,,,,,,19646.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15717.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9245.66,100,,,,,0,"case rate","100% of CMS IPPS rate",15717.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8188.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8188.97,19646.88,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC",58,CDM,100,RC,,,Inpatient,,,,,,23490.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18792.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12789.69,100,,,,,0,"case rate","100% of CMS IPPS rate",18792.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11327.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11327.96,23490.74,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC",59,CDM,100,RC,,,Inpatient,,,,,,19138.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15311.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8477.96,100,,,,,0,"case rate","100% of CMS IPPS rate",15311.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7509.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7509.01,19138.89,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC",60,CDM,100,RC,,,Inpatient,,,,,,16156.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12925.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6183.17,100,,,,,0,"case rate","100% of CMS IPPS rate",12925.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5476.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5476.5,16156.84,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,CDM,100,RC,,,Inpatient,,,,,,33219.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26575.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18731.05,100,,,,,0,"case rate","100% of CMS IPPS rate",26575.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16590.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16590.28,33219.76,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,CDM,100,RC,,,Inpatient,,,,,,23933.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19146.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12339.32,100,,,,,0,"case rate","100% of CMS IPPS rate",19146.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10929.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10929.06,23933.74,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,CDM,100,RC,,,Inpatient,,,,,,20651.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16521.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9733.44,100,,,,,0,"case rate","100% of CMS IPPS rate",16521.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8621,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8621,20651.73,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC",64,CDM,100,RC,,,Inpatient,,,,,,26290.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21032.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13782.57,100,,,,,0,"case rate","100% of CMS IPPS rate",21032.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12207.36,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12207.36,26290.78,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS",65,CDM,100,RC,,,Inpatient,,,,,,16997.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13597.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7045.8,100,,,,,0,"case rate","100% of CMS IPPS rate",13597.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6240.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6240.53,16997.31,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC",66,CDM,100,RC,,,Inpatient,,,,,,13970.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11176.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4769.02,100,,,,,0,"case rate","100% of CMS IPPS rate",11176.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4223.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4223.97,13970.69,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC",67,CDM,100,RC,,,Inpatient,,,,,,21254.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17003.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10080.57,100,,,,,0,"case rate","100% of CMS IPPS rate",17003.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8928.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8928.46,21254.46,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC",68,CDM,100,RC,,,Inpatient,,,,,,15642.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12513.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6107.65,100,,,,,0,"case rate","100% of CMS IPPS rate",12513.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5409.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5409.61,15642.35,
"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC",69,CDM,100,RC,,,Inpatient,,,,,,15033.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12026.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5543.65,100,,,,,0,"case rate","100% of CMS IPPS rate",12026.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4910.07,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4910.07,15033.11,
"OTHER CEREBROVASCULAR DISORDERS WITH MCC",70,CDM,100,RC,,,Inpatient,,,,,,23075.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18460.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12047.62,100,,,,,0,"case rate","100% of CMS IPPS rate",18460.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10670.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10670.7,23075.63,
"OTHER CEREBROVASCULAR DISORDERS WITH CC",71,CDM,100,RC,,,Inpatient,,,,,,17143.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13714.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7302.16,100,,,,,0,"case rate","100% of CMS IPPS rate",13714.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6467.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6467.59,17143.11,
"OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC",72,CDM,100,RC,,,Inpatient,,,,,,14637.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11710,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5197.91,100,,,,,0,"case rate","100% of CMS IPPS rate",11710,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4603.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4603.84,14637.5,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC",73,CDM,100,RC,,,Inpatient,,,,,,22513.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18011.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10709,100,,,,,0,"case rate","100% of CMS IPPS rate",18011.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9485.07,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9485.07,22513.76,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC",74,CDM,100,RC,,,Inpatient,,,,,,17187.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13750.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7222.48,100,,,,,0,"case rate","100% of CMS IPPS rate",13750.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6397.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6397.02,17187.7,
"VIRAL MENINGITIS WITH CC/MCC",75,CDM,100,RC,,,Inpatient,,,,,,25422.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20337.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11516.89,100,,,,,0,"case rate","100% of CMS IPPS rate",20337.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10200.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10200.62,25422.43,
"VIRAL MENINGITIS WITHOUT CC/MCC",76,CDM,100,RC,,,Inpatient,,,,,,15278.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12222.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6352.93,100,,,,,0,"case rate","100% of CMS IPPS rate",12222.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5626.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5626.85,15278.29,
"NONTRAUMATIC STUPOR AND COMA WITH MCC",80,CDM,100,RC,,,Inpatient,,,,,,24424.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19539.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13642.61,100,,,,,0,"case rate","100% of CMS IPPS rate",19539.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12083.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12083.4,24424.1,
"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC",81,CDM,100,RC,,,Inpatient,,,,,,15932.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12745.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6269.09,100,,,,,0,"case rate","100% of CMS IPPS rate",12745.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5552.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5552.59,15932.1,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC",82,CDM,100,RC,,,Inpatient,,,,,,28840.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23072.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16075.97,100,,,,,0,"case rate","100% of CMS IPPS rate",23072.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14238.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14238.65,28840.98,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC",83,CDM,100,RC,,,Inpatient,,,,,,20577.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16461.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9633.66,100,,,,,0,"case rate","100% of CMS IPPS rate",16461.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8532.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8532.63,20577.43,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC",84,CDM,100,RC,,,Inpatient,,,,,,16491.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13192.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6624.53,100,,,,,0,"case rate","100% of CMS IPPS rate",13192.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5867.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5867.41,16491.16,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC",85,CDM,100,RC,,,Inpatient,,,,,,28713.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22970.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15700.43,100,,,,,0,"case rate","100% of CMS IPPS rate",22970.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13906.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13906.03,28713.73,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC",86,CDM,100,RC,,,Inpatient,,,,,,19712.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15770.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9087.68,100,,,,,0,"case rate","100% of CMS IPPS rate",15770.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8049.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8049.05,19712.83,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC",87,CDM,100,RC,,,Inpatient,,,,,,16109.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12887.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6124.97,100,,,,,0,"case rate","100% of CMS IPPS rate",12887.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5424.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5424.95,16109.48,
"CONCUSSION WITH MCC",88,CDM,100,RC,,,Inpatient,,,,,,20168.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16135.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9774.32,100,,,,,0,"case rate","100% of CMS IPPS rate",16135.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8657.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8657.21,20168.8,
"CONCUSSION WITH CC",89,CDM,100,RC,,,Inpatient,,,,,,17817.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14253.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7428.26,100,,,,,0,"case rate","100% of CMS IPPS rate",14253.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6579.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6579.28,17817.36,
"CONCUSSION WITHOUT CC/MCC",90,CDM,100,RC,,,Inpatient,,,,,,15259.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12207.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5939.97,100,,,,,0,"case rate","100% of CMS IPPS rate",12207.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5261.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5261.1,15259.73,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC",91,CDM,100,RC,,,Inpatient,,,,,,23924.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19139.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12630.33,100,,,,,0,"case rate","100% of CMS IPPS rate",19139.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11186.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11186.81,23924.45,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC",92,CDM,100,RC,,,Inpatient,,,,,,17115.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13692.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7335.41,100,,,,,0,"case rate","100% of CMS IPPS rate",13692.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6497.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6497.05,17115.26,
"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC",93,CDM,100,RC,,,Inpatient,,,,,,15009.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12007.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5468.82,100,,,,,0,"case rate","100% of CMS IPPS rate",12007.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4843.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4843.79,15009.9,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC",94,CDM,100,RC,,,Inpatient,,,,,,40299.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32239.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25280.75,100,,,,,0,"case rate","100% of CMS IPPS rate",32239.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22391.42,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22391.42,40299.21,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC",95,CDM,100,RC,,,Inpatient,,,,,,31567.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25254.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16609.48,100,,,,,0,"case rate","100% of CMS IPPS rate",25254.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14711.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14711.18,31567.61,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC",96,CDM,100,RC,,,Inpatient,,,,,,31567.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25254.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16609.48,100,,,,,0,"case rate","100% of CMS IPPS rate",25254.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14711.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14711.18,31567.61,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC",97,CDM,100,RC,,,Inpatient,,,,,,41157.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32925.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24836.62,100,,,,,0,"case rate","100% of CMS IPPS rate",32925.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21998.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21998.04,41157.33,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC",98,CDM,100,RC,,,Inpatient,,,,,,28927.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23141.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15030.43,100,,,,,0,"case rate","100% of CMS IPPS rate",23141.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13312.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13312.6,28927.34,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC",99,CDM,100,RC,,,Inpatient,,,,,,20267.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16213.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9653.76,100,,,,,0,"case rate","100% of CMS IPPS rate",16213.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8550.43,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8550.43,20267.24,
"SEIZURES WITH MCC",100,CDM,100,RC,,,Inpatient,,,,,,25601.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20481.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13755.55,100,,,,,0,"case rate","100% of CMS IPPS rate",20481.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12183.43,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12183.43,25601.68,
"SEIZURES WITHOUT MCC",101,CDM,100,RC,,,Inpatient,,,,,,15997.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12797.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6386.18,100,,,,,0,"case rate","100% of CMS IPPS rate",12797.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5656.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5656.31,15997.1,
"HEADACHES WITH MCC",102,CDM,100,RC,,,Inpatient,,,,,,18024.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14419.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8033.83,100,,,,,0,"case rate","100% of CMS IPPS rate",14419.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7115.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7115.64,18024.45,
"HEADACHES WITHOUT MCC",103,CDM,100,RC,,,Inpatient,,,,,,15381.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12305.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5890.78,100,,,,,0,"case rate","100% of CMS IPPS rate",12305.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5217.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5217.52,15381.38,
"ORBITAL PROCEDURES WITH CC/MCC",113,CDM,100,RC,,,Inpatient,,,,,,29449.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23559.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15500.89,100,,,,,0,"case rate","100% of CMS IPPS rate",23559.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13729.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13729.29,29449.26,
"ORBITAL PROCEDURES WITHOUT CC/MCC",114,CDM,100,RC,,,Inpatient,,,,,,20179.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16143.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8190.42,100,,,,,0,"case rate","100% of CMS IPPS rate",16143.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7254.33,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7254.33,20179.96,
"EXTRAOCULAR PROCEDURES EXCEPT ORBIT",115,CDM,100,RC,,,Inpatient,,,,,,21869.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17495.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10607.84,100,,,,,0,"case rate","100% of CMS IPPS rate",17495.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9395.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9395.47,21869.24,
"INTRAOCULAR PROCEDURES WITH CC/MCC",116,CDM,100,RC,,,Inpatient,,,,,,24406.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19525.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11561.23,100,,,,,0,"case rate","100% of CMS IPPS rate",19525.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10239.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10239.9,24406.45,
"INTRAOCULAR PROCEDURES WITHOUT CC/MCC",117,CDM,100,RC,,,Inpatient,,,,,,17690.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14152.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7013.23,100,,,,,0,"case rate","100% of CMS IPPS rate",14152.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6211.69,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6211.69,17690.11,
"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC",121,CDM,100,RC,,,Inpatient,,,,,,18418.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14734.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8059.46,100,,,,,0,"case rate","100% of CMS IPPS rate",14734.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7138.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7138.35,18418.21,
"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC",122,CDM,100,RC,,,Inpatient,,,,,,14912.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11929.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4699.74,100,,,,,0,"case rate","100% of CMS IPPS rate",11929.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4162.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4162.61,14912.4,
"NEUROLOGICAL EYE DISORDERS",123,CDM,100,RC,,,Inpatient,,,,,,15031.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12025.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5565.13,100,,,,,0,"case rate","100% of CMS IPPS rate",12025.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4929.09,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4929.09,15031.26,
"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT",124,CDM,100,RC,,,Inpatient,,,,,,19902.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15921.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9034.33,100,,,,,0,"case rate","100% of CMS IPPS rate",15921.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8001.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8001.8,19902.28,
"OTHER DISORDERS OF THE EYE WITHOUT MCC",125,CDM,100,RC,,,Inpatient,,,,,,14745.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11796.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5721.03,100,,,,,0,"case rate","100% of CMS IPPS rate",11796.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5067.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5067.17,14745.23,
"SINUS AND MASTOID PROCEDURES WITH CC/MCC",135,CDM,100,RC,,,Inpatient,,,,,,27767.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22213.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16705.79,100,,,,,0,"case rate","100% of CMS IPPS rate",22213.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14796.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14796.49,27767.4,
"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC",136,CDM,100,RC,,,Inpatient,,,,,,17043.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13635,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6777.65,100,,,,,0,"case rate","100% of CMS IPPS rate",13635,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6003.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6003.04,17043.75,
"MOUTH PROCEDURES WITH CC/MCC",137,CDM,100,RC,,,Inpatient,,,,,,21481.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17185.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9690.48,100,,,,,0,"case rate","100% of CMS IPPS rate",17185.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8582.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8582.96,21481.99,
"MOUTH PROCEDURES WITHOUT CC/MCC",138,CDM,100,RC,,,Inpatient,,,,,,15844.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12675.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5636.5,100,,,,,0,"case rate","100% of CMS IPPS rate",12675.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4992.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4992.3,15844.79,
"SALIVARY GLAND PROCEDURES",139,CDM,100,RC,,,Inpatient,,,,,,19090.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15272.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9513.11,100,,,,,0,"case rate","100% of CMS IPPS rate",15272.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8425.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8425.85,19090.6,
"MAJOR HEAD AND NECK PROCEDURES WITH MCC",140,CDM,100,RC,,,Inpatient,,,,,,47226.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37781.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29302.86,100,,,,,0,"case rate","100% of CMS IPPS rate",37781.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25953.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25953.84,47226.35,
"MAJOR HEAD AND NECK PROCEDURES WITH CC",141,CDM,100,RC,,,Inpatient,,,,,,27870.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22296.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14886.31,100,,,,,0,"case rate","100% of CMS IPPS rate",22296.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13184.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13184.96,27870.48,
"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC",142,CDM,100,RC,,,Inpatient,,,,,,22440.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17952.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10894.69,100,,,,,0,"case rate","100% of CMS IPPS rate",17952.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9649.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9649.54,22440.4,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,CDM,100,RC,,,Inpatient,,,,,,42409.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33927.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22877.87,100,,,,,0,"case rate","100% of CMS IPPS rate",33927.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20263.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20263.17,42409.2,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,CDM,100,RC,,,Inpatient,,,,,,23708.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18966.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12171.65,100,,,,,0,"case rate","100% of CMS IPPS rate",18966.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10780.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10780.55,23708.06,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,CDM,100,RC,,,Inpatient,,,,,,18780.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15024.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8209.12,100,,,,,0,"case rate","100% of CMS IPPS rate",15024.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7270.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7270.9,18780.4,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,CDM,100,RC,,,Inpatient,,,,,,27278.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21823.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15895.13,100,,,,,0,"case rate","100% of CMS IPPS rate",21823.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14078.48,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14078.48,27278.9,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,CDM,100,RC,,,Inpatient,,,,,,19423.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15538.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8624.85,100,,,,,0,"case rate","100% of CMS IPPS rate",15538.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7639.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7639.11,19423.06,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,CDM,100,RC,,,Inpatient,,,,,,15017.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12013.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5288.68,100,,,,,0,"case rate","100% of CMS IPPS rate",12013.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4684.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4684.23,15017.33,
DYSEQUILIBRIUM,149,CDM,100,RC,,,Inpatient,,,,,,14594.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11675.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5179.2,100,,,,,0,"case rate","100% of CMS IPPS rate",11675.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4587.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4587.27,14594.78,
"EPISTAXIS WITH MCC",150,CDM,100,RC,,,Inpatient,,,,,,19980.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15984.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9576.85,100,,,,,0,"case rate","100% of CMS IPPS rate",15984.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8482.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8482.31,19980.29,
"EPISTAXIS WITHOUT MCC",151,CDM,100,RC,,,Inpatient,,,,,,14431.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11545.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5251.95,100,,,,,0,"case rate","100% of CMS IPPS rate",11545.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4651.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4651.71,14431.33,
"OTITIS MEDIA AND URI WITH MCC",152,CDM,100,RC,,,Inpatient,,,,,,18593.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14874.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7862.69,100,,,,,0,"case rate","100% of CMS IPPS rate",14874.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6964.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6964.06,18593.74,
"OTITIS MEDIA AND URI WITHOUT MCC",153,CDM,100,RC,,,Inpatient,,,,,,14470.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11576.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4931.16,100,,,,,0,"case rate","100% of CMS IPPS rate",11576.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4367.57,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4367.57,14470.34,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,CDM,100,RC,,,Inpatient,,,,,,22134.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17707.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11268.14,100,,,,,0,"case rate","100% of CMS IPPS rate",17707.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9980.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9980.31,22134.85,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,CDM,100,RC,,,Inpatient,,,,,,16126.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12900.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6468.63,100,,,,,0,"case rate","100% of CMS IPPS rate",12900.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5729.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5729.34,16126.2,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,CDM,100,RC,,,Inpatient,,,,,,14032.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11226.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4658.86,100,,,,,0,"case rate","100% of CMS IPPS rate",11226.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4126.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4126.4,14032.93,
"DENTAL AND ORAL DISEASES WITH MCC",157,CDM,100,RC,,,Inpatient,,,,,,23558.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18846.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11345.75,100,,,,,0,"case rate","100% of CMS IPPS rate",18846.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10049.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10049.04,23558.54,
"DENTAL AND ORAL DISEASES WITH CC",158,CDM,100,RC,,,Inpatient,,,,,,16063.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12851.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6517.14,100,,,,,0,"case rate","100% of CMS IPPS rate",12851.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5772.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5772.29,16063.98,
"DENTAL AND ORAL DISEASES WITHOUT CC/MCC",159,CDM,100,RC,,,Inpatient,,,,,,14194.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11355.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4570.17,100,,,,,0,"case rate","100% of CMS IPPS rate",11355.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4047.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4047.85,14194.5,
"MAJOR CHEST PROCEDURES WITH MCC",163,CDM,100,RC,,,Inpatient,,,,,,49236.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39389.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31935.76,100,,,,,0,"case rate","100% of CMS IPPS rate",39389.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28285.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28285.83,49236.98,
"MAJOR CHEST PROCEDURES WITH CC",164,CDM,100,RC,,,Inpatient,,,,,,31054.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24843.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17439.54,100,,,,,0,"case rate","100% of CMS IPPS rate",24843.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15446.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15446.38,31054.98,
"MAJOR CHEST PROCEDURES WITHOUT CC/MCC",165,CDM,100,RC,,,Inpatient,,,,,,25391.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20313.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12915.1,100,,,,,0,"case rate","100% of CMS IPPS rate",20313.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11439.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11439.03,25391.78,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC",166,CDM,100,RC,,,Inpatient,,,,,,42326.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33861.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26677.57,100,,,,,0,"case rate","100% of CMS IPPS rate",33861.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23628.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23628.6,42326.56,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC",167,CDM,100,RC,,,Inpatient,,,,,,24362.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19490.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12660.12,100,,,,,0,"case rate","100% of CMS IPPS rate",19490.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11213.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11213.2,24362.79,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",168,CDM,100,RC,,,Inpatient,,,,,,20304.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16243.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9380.77,100,,,,,0,"case rate","100% of CMS IPPS rate",16243.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8308.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8308.64,20304.4,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM",173,CDM,100,RC,,,Inpatient,,,,,,35256.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28205.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21261.41,100,,,,,0,"case rate","100% of CMS IPPS rate",28205.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18831.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18831.45,35256.4,
"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE",175,CDM,100,RC,,,Inpatient,,,,,,20371.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16297.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9763.23,100,,,,,0,"case rate","100% of CMS IPPS rate",16297.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8647.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8647.39,20371.26,
"PULMONARY EMBOLISM WITHOUT MCC",176,CDM,100,RC,,,Inpatient,,,,,,15090.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12072.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5643.43,100,,,,,0,"case rate","100% of CMS IPPS rate",12072.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4998.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4998.44,15090.7,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC",177,CDM,100,RC,,,Inpatient,,,,,,22127.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17701.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11200.24,100,,,,,0,"case rate","100% of CMS IPPS rate",17701.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9920.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9920.17,22127.41,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC",178,CDM,100,RC,,,Inpatient,,,,,,16678.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13343.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6873.96,100,,,,,0,"case rate","100% of CMS IPPS rate",13343.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6088.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6088.34,16678.78,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC",179,CDM,100,RC,,,Inpatient,,,,,,14626.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11701.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5333.02,100,,,,,0,"case rate","100% of CMS IPPS rate",11701.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4723.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4723.51,14626.36,
"RESPIRATORY NEOPLASMS WITH MCC",180,CDM,100,RC,,,Inpatient,,,,,,24015.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19212.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12109.98,100,,,,,0,"case rate","100% of CMS IPPS rate",19212.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10725.93,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10725.93,24015.46,
"RESPIRATORY NEOPLASMS WITH CC",181,CDM,100,RC,,,Inpatient,,,,,,17561.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14048.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7692.94,100,,,,,0,"case rate","100% of CMS IPPS rate",14048.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6813.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6813.71,17561.04,
"RESPIRATORY NEOPLASMS WITHOUT CC/MCC",182,CDM,100,RC,,,Inpatient,,,,,,14615.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11692.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5802.79,100,,,,,0,"case rate","100% of CMS IPPS rate",11692.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5139.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5139.59,14615.21,
"MAJOR CHEST TRAUMA WITH MCC",183,CDM,100,RC,,,Inpatient,,,,,,21822.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17458.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10997.93,100,,,,,0,"case rate","100% of CMS IPPS rate",17458.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9740.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9740.97,21822.83,
"MAJOR CHEST TRAUMA WITH CC",184,CDM,100,RC,,,Inpatient,,,,,,17496.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13997.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7400.54,100,,,,,0,"case rate","100% of CMS IPPS rate",13997.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6554.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6554.74,17496.95,
"MAJOR CHEST TRAUMA WITHOUT CC/MCC",185,CDM,100,RC,,,Inpatient,,,,,,14918.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11935.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5388.45,100,,,,,0,"case rate","100% of CMS IPPS rate",11935.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4772.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4772.6,14918.9,
"PLEURAL EFFUSION WITH MCC",186,CDM,100,RC,,,Inpatient,,,,,,22088.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17670.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10947.35,100,,,,,0,"case rate","100% of CMS IPPS rate",17670.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9696.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9696.18,22088.41,
"PLEURAL EFFUSION WITH CC",187,CDM,100,RC,,,Inpatient,,,,,,16800.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13440.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6956.41,100,,,,,0,"case rate","100% of CMS IPPS rate",13440.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6161.37,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6161.37,16800.43,
"PLEURAL EFFUSION WITHOUT CC/MCC",188,CDM,100,RC,,,Inpatient,,,,,,14275.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11420.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5087.05,100,,,,,0,"case rate","100% of CMS IPPS rate",11420.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4505.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4505.65,14275.3,
"PULMONARY EDEMA AND RESPIRATORY FAILURE",189,CDM,100,RC,,,Inpatient,,,,,,19087.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15270.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8573.57,100,,,,,0,"case rate","100% of CMS IPPS rate",15270.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7593.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7593.7,19087.8,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC",190,CDM,100,RC,,,Inpatient,,,,,,17901.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14321.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7780.93,100,,,,,0,"case rate","100% of CMS IPPS rate",14321.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6891.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6891.65,17901.85,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC",191,CDM,100,RC,,,Inpatient,,,,,,15443.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12354.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5952.45,100,,,,,0,"case rate","100% of CMS IPPS rate",12354.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5272.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5272.14,15443.61,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC",192,CDM,100,RC,,,Inpatient,,,,,,13576.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10861.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4484.25,100,,,,,0,"case rate","100% of CMS IPPS rate",10861.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3971.75,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3971.75,13576.93,
"SIMPLE PNEUMONIA AND PLEURISY WITH MCC",193,CDM,100,RC,,,Inpatient,,,,,,19821.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15857.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9129.95,100,,,,,0,"case rate","100% of CMS IPPS rate",15857.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8086.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8086.49,19821.48,
"SIMPLE PNEUMONIA AND PLEURISY WITH CC",194,CDM,100,RC,,,Inpatient,,,,,,15099.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12079.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5681.53,100,,,,,0,"case rate","100% of CMS IPPS rate",12079.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5032.19,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5032.19,15099.05,
"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC",195,CDM,100,RC,,,Inpatient,,,,,,13451.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10761.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4314.5,100,,,,,0,"case rate","100% of CMS IPPS rate",10761.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3821.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3821.4,13451.55,
"INTERSTITIAL LUNG DISEASE WITH MCC",196,CDM,100,RC,,,Inpatient,,,,,,25141.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20112.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13054.36,100,,,,,0,"case rate","100% of CMS IPPS rate",20112.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11562.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11562.38,25141.04,
"INTERSTITIAL LUNG DISEASE WITH CC",197,CDM,100,RC,,,Inpatient,,,,,,16428.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13143.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6859.41,100,,,,,0,"case rate","100% of CMS IPPS rate",13143.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6075.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6075.45,16428.95,
"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC",198,CDM,100,RC,,,Inpatient,,,,,,14266.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11412.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4663.02,100,,,,,0,"case rate","100% of CMS IPPS rate",11412.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4130.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4130.08,14266.03,
"PNEUMOTHORAX WITH MCC",199,CDM,100,RC,,,Inpatient,,,,,,23997.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19198.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12231.23,100,,,,,0,"case rate","100% of CMS IPPS rate",19198.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10833.33,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10833.33,23997.81,
"PNEUMOTHORAX WITH CC",200,CDM,100,RC,,,Inpatient,,,,,,17823.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14259.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7673.54,100,,,,,0,"case rate","100% of CMS IPPS rate",14259.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6796.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6796.53,17823.86,
"PNEUMOTHORAX WITHOUT CC/MCC",201,CDM,100,RC,,,Inpatient,,,,,,14255.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11404.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4691.42,100,,,,,0,"case rate","100% of CMS IPPS rate",11404.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4155.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4155.24,14255.8,
"BRONCHITIS AND ASTHMA WITH CC/MCC",202,CDM,100,RC,,,Inpatient,,,,,,16634.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13307.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6697.97,100,,,,,0,"case rate","100% of CMS IPPS rate",13307.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5932.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5932.46,16634.19,
"BRONCHITIS AND ASTHMA WITHOUT CC/MCC",203,CDM,100,RC,,,Inpatient,,,,,,13836.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11069.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4826.53,100,,,,,0,"case rate","100% of CMS IPPS rate",11069.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4274.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4274.91,13836.98,
"RESPIRATORY SIGNS AND SYMPTOMS",204,CDM,100,RC,,,Inpatient,,,,,,15112.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12090.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5619.18,100,,,,,0,"case rate","100% of CMS IPPS rate",12090.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4976.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4976.96,15112.99,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC",205,CDM,100,RC,,,Inpatient,,,,,,24619.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19695.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13080,100,,,,,0,"case rate","100% of CMS IPPS rate",19695.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11585.09,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11585.09,24619.11,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC",206,CDM,100,RC,,,Inpatient,,,,,,16354.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13083.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6276.02,100,,,,,0,"case rate","100% of CMS IPPS rate",13083.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5558.73,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5558.73,16354.65,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS",207,CDM,100,RC,,,Inpatient,,,,,,67373.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53898.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44809.29,100,,,,,0,"case rate","100% of CMS IPPS rate",53898.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39688.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39688.04,67373.46,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS",208,CDM,100,RC,,,Inpatient,,,,,,33141.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26513.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18595.25,100,,,,,0,"case rate","100% of CMS IPPS rate",26513.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16470,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16470,33141.75,
"COMPLEX AORTIC ARCH PROCEDURES",209,CDM,100,RC,,,Inpatient,,,,,,112731.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90185.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90185.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",90185.51,112731.89,
"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES",212,CDM,100,RC,,,Inpatient,,,,,,108601.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",86881.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",75480.56,100,,,,,0,"case rate","100% of CMS IPPS rate",86881.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",66853.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66853.9,108601.99,
"ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES",213,CDM,100,RC,,,Inpatient,,,,,,60614.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48491.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48491.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48491.54,60614.43,
"OTHER HEART ASSIST SYSTEM IMPLANT",215,CDM,100,RC,,,Inpatient,,,,,,100084.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",80067.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73408.19,100,,,,,0,"case rate","100% of CMS IPPS rate",80067.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",65018.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",65018.38,100084.91,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC",216,CDM,100,RC,,,Inpatient,,,,,,98467.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",78773.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",66869.58,100,,,,,0,"case rate","100% of CMS IPPS rate",78773.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",59227.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59227.06,98467.13,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC",217,CDM,100,RC,,,Inpatient,,,,,,68679.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54943.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44744.85,100,,,,,0,"case rate","100% of CMS IPPS rate",54943.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",39630.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39630.97,68679.21,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC",218,CDM,100,RC,,,Inpatient,,,,,,68679.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54943.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41220.91,100,,,,,0,"case rate","100% of CMS IPPS rate",54943.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36509.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36509.78,68679.21,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC",219,CDM,100,RC,,,Inpatient,,,,,,78922.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",63138.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",53610.82,100,,,,,0,"case rate","100% of CMS IPPS rate",63138.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",47483.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47483.64,78922.73,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC",220,CDM,100,RC,,,Inpatient,,,,,,57140.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45712.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36699.25,100,,,,,0,"case rate","100% of CMS IPPS rate",45712.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32504.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32504.89,57140.18,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC",221,CDM,100,RC,,,Inpatient,,,,,,54422.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43538.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31820.75,100,,,,,0,"case rate","100% of CMS IPPS rate",43538.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28183.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28183.96,54422.81,
"OTHER CARDIOTHORACIC PROCEDURES WITH MCC",228,CDM,100,RC,,,Inpatient,,,,,,53560.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42848.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34527.79,100,,,,,0,"case rate","100% of CMS IPPS rate",42848.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30581.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30581.62,53560.98,
"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC",229,CDM,100,RC,,,Inpatient,,,,,,36863.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29491.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21522.62,100,,,,,0,"case rate","100% of CMS IPPS rate",29491.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19062.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19062.8,36863.96,
"CORONARY BYPASS WITH PTCA WITH MCC",231,CDM,100,RC,,,Inpatient,,,,,,85902.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",68722.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58713.11,100,,,,,0,"case rate","100% of CMS IPPS rate",68722.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",52002.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",52002.8,85902.81,
"CORONARY BYPASS WITH PTCA WITHOUT MCC",232,CDM,100,RC,,,Inpatient,,,,,,63917.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51134.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42325.35,100,,,,,0,"case rate","100% of CMS IPPS rate",51134.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37487.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37487.99,63917.79,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC",233,CDM,100,RC,,,Inpatient,,,,,,78615.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",62892.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54157.49,100,,,,,0,"case rate","100% of CMS IPPS rate",62892.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",47967.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47967.84,78615.33,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC",234,CDM,100,RC,,,Inpatient,,,,,,58346.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46677.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36862.07,100,,,,,0,"case rate","100% of CMS IPPS rate",46677.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",32649.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32649.11,58346.54,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC",235,CDM,100,RC,,,Inpatient,,,,,,62116.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49692.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40769.86,100,,,,,0,"case rate","100% of CMS IPPS rate",49692.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36110.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36110.28,62116.13,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC",236,CDM,100,RC,,,Inpatient,,,,,,46515.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37212.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28491.51,100,,,,,0,"case rate","100% of CMS IPPS rate",37212.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25235.22,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25235.22,46515.89,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC",239,CDM,100,RC,,,Inpatient,,,,,,53322.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42657.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34899.17,100,,,,,0,"case rate","100% of CMS IPPS rate",42657.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30910.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30910.55,53322.31,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC",240,CDM,100,RC,,,Inpatient,,,,,,34087.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27269.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20177.76,100,,,,,0,"case rate","100% of CMS IPPS rate",27269.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17871.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17871.65,34087.18,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC",241,CDM,100,RC,,,Inpatient,,,,,,20471.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16377.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10461.64,100,,,,,0,"case rate","100% of CMS IPPS rate",16377.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9265.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9265.98,20471.56,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC",242,CDM,100,RC,,,Inpatient,,,,,,37266.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29812.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23502.15,100,,,,,0,"case rate","100% of CMS IPPS rate",29812.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20816.09,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20816.09,37266.09,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC",243,CDM,100,RC,,,Inpatient,,,,,,27404.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21923.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15608.98,100,,,,,0,"case rate","100% of CMS IPPS rate",21923.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13825.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13825.03,27404.29,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC",244,CDM,100,RC,,,Inpatient,,,,,,24400.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19520.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12504.22,100,,,,,0,"case rate","100% of CMS IPPS rate",19520.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11075.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11075.12,24400.88,
"AICD GENERATOR PROCEDURES",245,CDM,100,RC,,,Inpatient,,,,,,49985.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39988.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33859.17,100,,,,,0,"case rate","100% of CMS IPPS rate",39988.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29989.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29989.41,49985.51,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC",250,CDM,100,RC,,,Inpatient,,,,,,27883.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22306.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16023.31,100,,,,,0,"case rate","100% of CMS IPPS rate",22306.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14192.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14192.01,27883.49,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC",251,CDM,100,RC,,,Inpatient,,,,,,21494.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17195.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10826.79,100,,,,,0,"case rate","100% of CMS IPPS rate",17195.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9589.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9589.39,21494.05,
"OTHER VASCULAR PROCEDURES WITH MCC",252,CDM,100,RC,,,Inpatient,,,,,,40010.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32008.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23768.21,100,,,,,0,"case rate","100% of CMS IPPS rate",32008.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21051.75,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21051.75,40010.39,
"OTHER VASCULAR PROCEDURES WITH CC",253,CDM,100,RC,,,Inpatient,,,,,,31719.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25375.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17688.97,100,,,,,0,"case rate","100% of CMS IPPS rate",25375.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15667.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15667.3,31719.91,
"OTHER VASCULAR PROCEDURES WITHOUT CC/MCC",254,CDM,100,RC,,,Inpatient,,,,,,24161.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19329.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12121.07,100,,,,,0,"case rate","100% of CMS IPPS rate",19329.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10735.75,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10735.75,24161.28,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC",255,CDM,100,RC,,,Inpatient,,,,,,32665.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26132.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18128.94,100,,,,,0,"case rate","100% of CMS IPPS rate",26132.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16056.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16056.99,32665.34,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC",256,CDM,100,RC,,,Inpatient,,,,,,23383.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18706.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11735.14,100,,,,,0,"case rate","100% of CMS IPPS rate",18706.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10393.93,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10393.93,23383.03,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC",257,CDM,100,RC,,,Inpatient,,,,,,17757.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14206.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5491.69,100,,,,,0,"case rate","100% of CMS IPPS rate",14206.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4864.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4864.04,17757.93,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC",258,CDM,100,RC,,,Inpatient,,,,,,36795.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29436.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19438.47,100,,,,,0,"case rate","100% of CMS IPPS rate",29436.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17216.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17216.85,36795.24,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC",259,CDM,100,RC,,,Inpatient,,,,,,26393.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21115.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12178.58,100,,,,,0,"case rate","100% of CMS IPPS rate",21115.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10786.69,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10786.69,26393.85,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC",260,CDM,100,RC,,,Inpatient,,,,,,37823.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30258.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23600.54,100,,,,,0,"case rate","100% of CMS IPPS rate",30258.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20903.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20903.24,37823.3,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC",261,CDM,100,RC,,,Inpatient,,,,,,25171.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20137.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13147.9,100,,,,,0,"case rate","100% of CMS IPPS rate",20137.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11645.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11645.23,25171.69,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC",262,CDM,100,RC,,,Inpatient,,,,,,22751.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18201.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10516.38,100,,,,,0,"case rate","100% of CMS IPPS rate",18201.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9314.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9314.47,22751.51,
"VEIN LIGATION AND STRIPPING",263,CDM,100,RC,,,Inpatient,,,,,,36008.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28806.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18583.47,100,,,,,0,"case rate","100% of CMS IPPS rate",28806.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16459.56,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16459.56,36008.63,
"OTHER CIRCULATORY SYSTEM O.R. PROCEDURES",264,CDM,100,RC,,,Inpatient,,,,,,38638.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30910.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24216.5,100,,,,,0,"case rate","100% of CMS IPPS rate",30910.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21448.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21448.8,38638.7,
"AICD LEAD PROCEDURES",265,CDM,100,RC,,,Inpatient,,,,,,41216.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32973.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24716.06,100,,,,,0,"case rate","100% of CMS IPPS rate",32973.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21891.26,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21891.26,41216.78,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC",266,CDM,100,RC,,,Inpatient,,,,,,64528.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51623.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41508.46,100,,,,,0,"case rate","100% of CMS IPPS rate",51623.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36764.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36764.46,64528.88,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC",267,CDM,100,RC,,,Inpatient,,,,,,51828.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41462.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32597.45,100,,,,,0,"case rate","100% of CMS IPPS rate",41462.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28871.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28871.9,51828.03,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC",268,CDM,100,RC,,,Inpatient,,,,,,71489.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57191.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46197.8,100,,,,,0,"case rate","100% of CMS IPPS rate",57191.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40917.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40917.86,71489.44,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC",269,CDM,100,RC,,,Inpatient,,,,,,46835.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37468.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28828.24,100,,,,,0,"case rate","100% of CMS IPPS rate",37468.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25533.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25533.47,46835.36,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC",270,CDM,100,RC,,,Inpatient,,,,,,56615.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45292.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35565.02,100,,,,,0,"case rate","100% of CMS IPPS rate",45292.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31500.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31500.3,56615.45,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC",271,CDM,100,RC,,,Inpatient,,,,,,40641.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32513.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23865.21,100,,,,,0,"case rate","100% of CMS IPPS rate",32513.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21137.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21137.66,40641.91,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC",272,CDM,100,RC,,,Inpatient,,,,,,31324.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25059.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17336.99,100,,,,,0,"case rate","100% of CMS IPPS rate",25059.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15355.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15355.55,31324.29,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC",273,CDM,100,RC,,,Inpatient,,,,,,45928.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36742.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27093.3,100,,,,,0,"case rate","100% of CMS IPPS rate",36742.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23996.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23996.81,45928.03,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC",274,CDM,100,RC,,,Inpatient,,,,,,38184.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30547.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21624.47,100,,,,,0,"case rate","100% of CMS IPPS rate",30547.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19153.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19153.02,38184.58,
"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC",275,CDM,100,RC,,,Inpatient,,,,,,73834.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59067.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48965.12,100,,,,,0,"case rate","100% of CMS IPPS rate",59067.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43368.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43368.91,73834.4,
"CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR",276,CDM,100,RC,,,Inpatient,,,,,,63397.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50718.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42919.14,100,,,,,0,"case rate","100% of CMS IPPS rate",50718.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38013.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38013.92,63397.71,
"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC",277,CDM,100,RC,,,Inpatient,,,,,,50506.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40405.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32231.62,100,,,,,0,"case rate","100% of CMS IPPS rate",40405.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28547.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28547.87,50506.5,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC",278,CDM,100,RC,,,Inpatient,,,,,,59307.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47446.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34666.36,100,,,,,0,"case rate","100% of CMS IPPS rate",47446.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30704.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30704.35,59307.75,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC",279,CDM,100,RC,,,Inpatient,,,,,,41107.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32885.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22202.33,100,,,,,0,"case rate","100% of CMS IPPS rate",32885.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19664.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19664.83,41107.18,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,CDM,100,RC,,,Inpatient,,,,,,22511.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18009.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11372.77,100,,,,,0,"case rate","100% of CMS IPPS rate",18009.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10072.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10072.98,22511.91,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,CDM,100,RC,,,Inpatient,,,,,,16150.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12920.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6386.88,100,,,,,0,"case rate","100% of CMS IPPS rate",12920.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5656.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5656.92,16150.34,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,CDM,100,RC,,,Inpatient,,,,,,14330.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11464.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5024,100,,,,,0,"case rate","100% of CMS IPPS rate",11464.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4449.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4449.81,14330.11,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,CDM,100,RC,,,Inpatient,,,,,,26010.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20808.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13548.38,100,,,,,0,"case rate","100% of CMS IPPS rate",20808.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11999.94,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11999.94,26010.3,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,CDM,100,RC,,,Inpatient,,,,,,14043.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11234.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5134.17,100,,,,,0,"case rate","100% of CMS IPPS rate",11234.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4547.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4547.38,14043.13,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,CDM,100,RC,,,Inpatient,,,,,,13176.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10541.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3889.77,100,,,,,0,"case rate","100% of CMS IPPS rate",10541.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3445.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3445.21,13176.66,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,CDM,100,RC,,,Inpatient,,,,,,28164.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22531.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15335.29,100,,,,,0,"case rate","100% of CMS IPPS rate",22531.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13582.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13582.62,28164.88,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,CDM,100,RC,,,Inpatient,,,,,,17552.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14042.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7550.2,100,,,,,0,"case rate","100% of CMS IPPS rate",14042.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6687.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6687.29,17552.66,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC",288,CDM,100,RC,,,Inpatient,,,,,,32747.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26197.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18925.74,100,,,,,0,"case rate","100% of CMS IPPS rate",26197.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16762.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16762.72,32747.06,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC",289,CDM,100,RC,,,Inpatient,,,,,,23466.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18773.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10924.48,100,,,,,0,"case rate","100% of CMS IPPS rate",18773.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9675.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9675.92,23466.59,
"ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC",290,CDM,100,RC,,,Inpatient,,,,,,16248.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12999.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6783.2,100,,,,,0,"case rate","100% of CMS IPPS rate",12999.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6007.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6007.95,16248.8,
"HEART FAILURE AND SHOCK WITH MCC",291,CDM,100,RC,,,Inpatient,,,,,,19537.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15629.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9040.57,100,,,,,0,"case rate","100% of CMS IPPS rate",15629.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8007.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8007.32,19537.29,
"HEART FAILURE AND SHOCK WITH CC",292,CDM,100,RC,,,Inpatient,,,,,,15499.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12399.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5967,100,,,,,0,"case rate","100% of CMS IPPS rate",12399.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5285.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5285.03,15499.33,
"HEART FAILURE AND SHOCK WITHOUT CC/MCC",293,CDM,100,RC,,,Inpatient,,,,,,12871.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10296.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3801.78,100,,,,,0,"case rate","100% of CMS IPPS rate",10296.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3367.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3367.27,12871.11,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,CDM,100,RC,,,Inpatient,,,,,,22119.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17695.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11351.98,100,,,,,0,"case rate","100% of CMS IPPS rate",17695.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10054.57,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10054.57,22119.99,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,CDM,100,RC,,,Inpatient,,,,,,13502.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10802.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4880.58,100,,,,,0,"case rate","100% of CMS IPPS rate",10802.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4322.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4322.78,13502.64,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,CDM,100,RC,,,Inpatient,,,,,,11841.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9472.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3060.41,100,,,,,0,"case rate","100% of CMS IPPS rate",9472.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",2710.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",2710.63,11841.19,
"PERIPHERAL VASCULAR DISORDERS WITH MCC",299,CDM,100,RC,,,Inpatient,,,,,,22777.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18222.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11207.87,100,,,,,0,"case rate","100% of CMS IPPS rate",18222.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9926.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9926.92,22777.51,
"PERIPHERAL VASCULAR DISORDERS WITH CC",300,CDM,100,RC,,,Inpatient,,,,,,17528.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14022.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7417.87,100,,,,,0,"case rate","100% of CMS IPPS rate",14022.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6570.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6570.08,17528.54,
"PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC",301,CDM,100,RC,,,Inpatient,,,,,,14298.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11438.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4942.93,100,,,,,0,"case rate","100% of CMS IPPS rate",11438.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4378.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4378.01,14298.53,
"ATHEROSCLEROSIS WITH MCC",302,CDM,100,RC,,,Inpatient,,,,,,18727.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14981.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8060.16,100,,,,,0,"case rate","100% of CMS IPPS rate",14981.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7138.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7138.96,18727.48,
"ATHEROSCLEROSIS WITHOUT MCC",303,CDM,100,RC,,,Inpatient,,,,,,13866.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11093.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4658.86,100,,,,,0,"case rate","100% of CMS IPPS rate",11093.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4126.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4126.4,13866.69,
"HYPERTENSION WITH MCC",304,CDM,100,RC,,,Inpatient,,,,,,18666.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14932.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8139.84,100,,,,,0,"case rate","100% of CMS IPPS rate",14932.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7209.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7209.54,18666.16,
"HYPERTENSION WITHOUT MCC",305,CDM,100,RC,,,Inpatient,,,,,,14627.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11701.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5201.38,100,,,,,0,"case rate","100% of CMS IPPS rate",11701.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4606.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4606.91,14627.29,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC",306,CDM,100,RC,,,Inpatient,,,,,,22249.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17799.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10375.04,100,,,,,0,"case rate","100% of CMS IPPS rate",17799.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9189.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9189.27,22249.09,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC",307,CDM,100,RC,,,Inpatient,,,,,,16095.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12876.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6418.75,100,,,,,0,"case rate","100% of CMS IPPS rate",12876.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5685.15,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5685.15,16095.54,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC",308,CDM,100,RC,,,Inpatient,,,,,,18796.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15036.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8355.32,100,,,,,0,"case rate","100% of CMS IPPS rate",15036.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7400.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7400.39,18796.19,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC",309,CDM,100,RC,,,Inpatient,,,,,,14447.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11557.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5122.39,100,,,,,0,"case rate","100% of CMS IPPS rate",11557.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4536.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4536.95,14447.11,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC",310,CDM,100,RC,,,Inpatient,,,,,,12872.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10297.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3876.61,100,,,,,0,"case rate","100% of CMS IPPS rate",10297.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3433.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3433.55,12872.03,
"ANGINA PECTORIS",311,CDM,100,RC,,,Inpatient,,,,,,14133.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11306.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4838.31,100,,,,,0,"case rate","100% of CMS IPPS rate",11306.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4285.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4285.34,14133.23,
"SYNCOPE AND COLLAPSE",312,CDM,100,RC,,,Inpatient,,,,,,15709.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12567.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6036.98,100,,,,,0,"case rate","100% of CMS IPPS rate",12567.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5347.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5347.01,15709.21,
"CHEST PAIN",313,CDM,100,RC,,,Inpatient,,,,,,14301.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11441.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4942.93,100,,,,,0,"case rate","100% of CMS IPPS rate",11441.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4378.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4378.01,14301.31,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC",314,CDM,100,RC,,,Inpatient,,,,,,26979.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21583.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14920.96,100,,,,,0,"case rate","100% of CMS IPPS rate",21583.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13215.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13215.64,26979.85,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC",315,CDM,100,RC,,,Inpatient,,,,,,16560.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13248.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6667.49,100,,,,,0,"case rate","100% of CMS IPPS rate",13248.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5905.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5905.46,16560.83,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC",316,CDM,100,RC,,,Inpatient,,,,,,13949.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11159.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4730.22,100,,,,,0,"case rate","100% of CMS IPPS rate",11159.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4189.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4189.61,13949.33,
"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION",317,CDM,100,RC,,,Inpatient,,,,,,69711.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",55769.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42863.71,100,,,,,0,"case rate","100% of CMS IPPS rate",55769.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37964.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37964.82,69711.93,
"PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE",318,CDM,100,RC,,,Inpatient,,,,,,30109.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24087.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24087.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24087.64,30109.55,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC",319,CDM,100,RC,,,Inpatient,,,,,,49061.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39249.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30436.39,100,,,,,0,"case rate","100% of CMS IPPS rate",39249.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26957.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26957.82,49061.45,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC",320,CDM,100,RC,,,Inpatient,,,,,,29952.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23962.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16038.55,100,,,,,0,"case rate","100% of CMS IPPS rate",23962.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14205.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14205.51,29952.61,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES",321,CDM,100,RC,,,Inpatient,,,,,,32882.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26306.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19724.62,100,,,,,0,"case rate","100% of CMS IPPS rate",26306.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17470.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17470.3,32882.66,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC",322,CDM,100,RC,,,Inpatient,,,,,,23987.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19190.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12535.4,100,,,,,0,"case rate","100% of CMS IPPS rate",19190.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11102.73,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11102.73,23987.59,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC",323,CDM,100,RC,,,Inpatient,,,,,,47803.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38242.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29512.1,100,,,,,0,"case rate","100% of CMS IPPS rate",38242.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26139.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26139.17,47803.08,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC",324,CDM,100,RC,,,Inpatient,,,,,,36877.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29502.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22137.89,100,,,,,0,"case rate","100% of CMS IPPS rate",29502.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19607.75,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19607.75,36877.9,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE",325,CDM,100,RC,,,Inpatient,,,,,,37429.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29943.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19830.63,100,,,,,0,"case rate","100% of CMS IPPS rate",29943.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17564.19,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17564.19,37429.54,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,CDM,100,RC,,,Inpatient,,,,,,53932.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43145.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35190.87,100,,,,,0,"case rate","100% of CMS IPPS rate",43145.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31168.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31168.91,53932.46,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,CDM,100,RC,,,Inpatient,,,,,,30313.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24251.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16823.58,100,,,,,0,"case rate","100% of CMS IPPS rate",24251.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14900.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14900.81,30313.88,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,CDM,100,RC,,,Inpatient,,,,,,22495.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17996.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11040.88,100,,,,,0,"case rate","100% of CMS IPPS rate",17996.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9779.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9779.02,22495.19,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",329,CDM,100,RC,,,Inpatient,,,,,,50302.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40241.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31815.9,100,,,,,0,"case rate","100% of CMS IPPS rate",40241.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28179.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28179.66,50302.19,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",330,CDM,100,RC,,,Inpatient,,,,,,29877.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23901.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16377.37,100,,,,,0,"case rate","100% of CMS IPPS rate",23901.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14505.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14505.6,29877.39,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",331,CDM,100,RC,,,Inpatient,,,,,,23243.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18594.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11439.28,100,,,,,0,"case rate","100% of CMS IPPS rate",18594.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10131.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10131.89,23243.71,
"RECTAL RESECTION WITH MCC",332,CDM,100,RC,,,Inpatient,,,,,,41239.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32991.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24033.58,100,,,,,0,"case rate","100% of CMS IPPS rate",32991.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21286.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21286.79,41239.98,
"RECTAL RESECTION WITH CC",333,CDM,100,RC,,,Inpatient,,,,,,29366.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23493.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14725.57,100,,,,,0,"case rate","100% of CMS IPPS rate",23493.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13042.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13042.58,29366.59,
"RECTAL RESECTION WITHOUT CC/MCC",334,CDM,100,RC,,,Inpatient,,,,,,22825.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18260.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11491.94,100,,,,,0,"case rate","100% of CMS IPPS rate",18260.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10178.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10178.53,22825.81,
"PERITONEAL ADHESIOLYSIS WITH MCC",335,CDM,100,RC,,,Inpatient,,,,,,40777.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32621.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25105.45,100,,,,,0,"case rate","100% of CMS IPPS rate",32621.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22236.15,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22236.15,40777.48,
"PERITONEAL ADHESIOLYSIS WITH CC",336,CDM,100,RC,,,Inpatient,,,,,,27198.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21758.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14635.49,100,,,,,0,"case rate","100% of CMS IPPS rate",21758.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12962.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12962.8,27198.09,
"PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC",337,CDM,100,RC,,,Inpatient,,,,,,21870.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17496.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10636.25,100,,,,,0,"case rate","100% of CMS IPPS rate",17496.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9420.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9420.63,21870.16,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",344,CDM,100,RC,,,Inpatient,,,,,,31601.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25280.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18669.38,100,,,,,0,"case rate","100% of CMS IPPS rate",25280.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16535.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16535.66,31601.05,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",345,CDM,100,RC,,,Inpatient,,,,,,21588.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17271.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10314.76,100,,,,,0,"case rate","100% of CMS IPPS rate",17271.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9135.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9135.88,21588.79,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",346,CDM,100,RC,,,Inpatient,,,,,,18630.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14904.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8628.31,100,,,,,0,"case rate","100% of CMS IPPS rate",14904.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7642.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7642.18,18630.89,
"ANAL AND STOMAL PROCEDURES WITH MCC",347,CDM,100,RC,,,Inpatient,,,,,,28933.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23147.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16398.85,100,,,,,0,"case rate","100% of CMS IPPS rate",23147.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14524.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14524.63,28933.84,
"ANAL AND STOMAL PROCEDURES WITH CC",348,CDM,100,RC,,,Inpatient,,,,,,19769.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15815.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8722.54,100,,,,,0,"case rate","100% of CMS IPPS rate",15815.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7725.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7725.64,19769.46,
"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC",349,CDM,100,RC,,,Inpatient,,,,,,15699.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12559.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6103.49,100,,,,,0,"case rate","100% of CMS IPPS rate",12559.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5405.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5405.92,15699.93,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC",350,CDM,100,RC,,,Inpatient,,,,,,30756.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24605.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16758.45,100,,,,,0,"case rate","100% of CMS IPPS rate",24605.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14843.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14843.13,30756.86,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC",351,CDM,100,RC,,,Inpatient,,,,,,21772.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17418.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10424.23,100,,,,,0,"case rate","100% of CMS IPPS rate",17418.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9232.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9232.85,21772.66,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC",352,CDM,100,RC,,,Inpatient,,,,,,18460,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14768,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7639.58,100,,,,,0,"case rate","100% of CMS IPPS rate",14768,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6766.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6766.46,18460,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC",353,CDM,100,RC,,,Inpatient,,,,,,34565.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27652.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20321.88,100,,,,,0,"case rate","100% of CMS IPPS rate",27652.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17999.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17999.29,34565.45,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC",354,CDM,100,RC,,,Inpatient,,,,,,23239.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18591.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11786.41,100,,,,,0,"case rate","100% of CMS IPPS rate",18591.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10439.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10439.34,23239.08,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC",355,CDM,100,RC,,,Inpatient,,,,,,20105.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16084.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9237.34,100,,,,,0,"case rate","100% of CMS IPPS rate",16084.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8181.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8181.61,20105.66,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC",356,CDM,100,RC,,,Inpatient,,,,,,48410.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38728.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29555.76,100,,,,,0,"case rate","100% of CMS IPPS rate",38728.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26177.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26177.83,48410.45,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC",357,CDM,100,RC,,,Inpatient,,,,,,29211.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23369.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15603.43,100,,,,,0,"case rate","100% of CMS IPPS rate",23369.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13820.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13820.12,29211.53,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",358,CDM,100,RC,,,Inpatient,,,,,,20596.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16477.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9389.08,100,,,,,0,"case rate","100% of CMS IPPS rate",16477.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8316,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8316,20596.93,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC",359,CDM,100,RC,,,Inpatient,,,,,,39548.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31639.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31639.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31639.06,39548.83,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC",360,CDM,100,RC,,,Inpatient,,,,,,30036.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24028.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24028.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24028.96,30036.2,
"MAJOR ESOPHAGEAL DISORDERS WITH MCC",368,CDM,100,RC,,,Inpatient,,,,,,22398.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17918.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11570.93,100,,,,,0,"case rate","100% of CMS IPPS rate",17918.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10248.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10248.49,22398.59,
"MAJOR ESOPHAGEAL DISORDERS WITH CC",369,CDM,100,RC,,,Inpatient,,,,,,16903.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13522.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7050.65,100,,,,,0,"case rate","100% of CMS IPPS rate",13522.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6244.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6244.83,16903.51,
"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC",370,CDM,100,RC,,,Inpatient,,,,,,14123,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11298.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4836.23,100,,,,,0,"case rate","100% of CMS IPPS rate",11298.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4283.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4283.5,14123,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC",371,CDM,100,RC,,,Inpatient,,,,,,24081.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19265.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12111.37,100,,,,,0,"case rate","100% of CMS IPPS rate",19265.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10727.16,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10727.16,24081.4,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC",372,CDM,100,RC,,,Inpatient,,,,,,17096.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13677.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7131.71,100,,,,,0,"case rate","100% of CMS IPPS rate",13677.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6316.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6316.63,17096.68,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC",373,CDM,100,RC,,,Inpatient,,,,,,14370.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11496.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5026.08,100,,,,,0,"case rate","100% of CMS IPPS rate",11496.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4451.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4451.65,14370.04,
"DIGESTIVE MALIGNANCY WITH MCC",374,CDM,100,RC,,,Inpatient,,,,,,27476.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21981.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14629.26,100,,,,,0,"case rate","100% of CMS IPPS rate",21981.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12957.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12957.28,27476.71,
"DIGESTIVE MALIGNANCY WITH CC",375,CDM,100,RC,,,Inpatient,,,,,,18848.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15078.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8513.29,100,,,,,0,"case rate","100% of CMS IPPS rate",15078.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7540.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7540.31,18848.2,
"DIGESTIVE MALIGNANCY WITHOUT CC/MCC",376,CDM,100,RC,,,Inpatient,,,,,,16198.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12958.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6118.04,100,,,,,0,"case rate","100% of CMS IPPS rate",12958.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5418.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5418.81,16198.64,
"GASTROINTESTINAL HEMORRHAGE WITH MCC",377,CDM,100,RC,,,Inpatient,,,,,,24591.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19673,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12597.76,100,,,,,0,"case rate","100% of CMS IPPS rate",19673,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11157.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11157.97,24591.25,
"GASTROINTESTINAL HEMORRHAGE WITH CC",378,CDM,100,RC,,,Inpatient,,,,,,16722.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13377.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6831.01,100,,,,,0,"case rate","100% of CMS IPPS rate",13377.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6050.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6050.29,16722.43,
"GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC",379,CDM,100,RC,,,Inpatient,,,,,,13469.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10775.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4411.5,100,,,,,0,"case rate","100% of CMS IPPS rate",10775.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3907.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3907.31,13469.19,
"COMPLICATED PEPTIC ULCER WITH MCC",380,CDM,100,RC,,,Inpatient,,,,,,25837.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20670.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13332.9,100,,,,,0,"case rate","100% of CMS IPPS rate",20670.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11809.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11809.08,25837.56,
"COMPLICATED PEPTIC ULCER WITH CC",381,CDM,100,RC,,,Inpatient,,,,,,17677.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14141.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7546.05,100,,,,,0,"case rate","100% of CMS IPPS rate",14141.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6683.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6683.61,17677.11,
"COMPLICATED PEPTIC ULCER WITHOUT CC/MCC",382,CDM,100,RC,,,Inpatient,,,,,,15049.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12039.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5191.67,100,,,,,0,"case rate","100% of CMS IPPS rate",12039.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4598.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4598.32,15049.84,
"UNCOMPLICATED PEPTIC ULCER WITH MCC",383,CDM,100,RC,,,Inpatient,,,,,,20437.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16349.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8759.26,100,,,,,0,"case rate","100% of CMS IPPS rate",16349.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7758.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7758.17,20437.2,
"UNCOMPLICATED PEPTIC ULCER WITHOUT MCC",384,CDM,100,RC,,,Inpatient,,,,,,15553.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12442.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6025.2,100,,,,,0,"case rate","100% of CMS IPPS rate",12442.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5336.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5336.58,15553.18,
"INFLAMMATORY BOWEL DISEASE WITH MCC",385,CDM,100,RC,,,Inpatient,,,,,,22309.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17847.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11257.75,100,,,,,0,"case rate","100% of CMS IPPS rate",17847.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9971.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9971.11,22309.46,
"INFLAMMATORY BOWEL DISEASE WITH CC",386,CDM,100,RC,,,Inpatient,,,,,,16681.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13345.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6876.73,100,,,,,0,"case rate","100% of CMS IPPS rate",13345.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6090.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6090.79,16681.55,
"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC",387,CDM,100,RC,,,Inpatient,,,,,,13941.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11153.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4644.31,100,,,,,0,"case rate","100% of CMS IPPS rate",11153.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4113.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4113.51,13941.9,
"GASTROINTESTINAL OBSTRUCTION WITH MCC",388,CDM,100,RC,,,Inpatient,,,,,,21329.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17063.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10184.5,100,,,,,0,"case rate","100% of CMS IPPS rate",17063.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9020.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9020.51,21329.68,
"GASTROINTESTINAL OBSTRUCTION WITH CC",389,CDM,100,RC,,,Inpatient,,,,,,14949.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11959.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5554.05,100,,,,,0,"case rate","100% of CMS IPPS rate",11959.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4919.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4919.27,14949.54,
"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC",390,CDM,100,RC,,,Inpatient,,,,,,12666.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10133.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3791.38,100,,,,,0,"case rate","100% of CMS IPPS rate",10133.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3358.07,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3358.07,12666.8,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,CDM,100,RC,,,Inpatient,,,,,,19393.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15514.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8899.92,100,,,,,0,"case rate","100% of CMS IPPS rate",15514.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7882.75,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7882.75,19393.35,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,CDM,100,RC,,,Inpatient,,,,,,14854.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11883.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5406.46,100,,,,,0,"case rate","100% of CMS IPPS rate",11883.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4788.56,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4788.56,14854.81,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC",393,CDM,100,RC,,,Inpatient,,,,,,22467.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17973.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11473.93,100,,,,,0,"case rate","100% of CMS IPPS rate",17973.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10162.57,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10162.57,22467.33,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC",394,CDM,100,RC,,,Inpatient,,,,,,16304.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13043.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6521.99,100,,,,,0,"case rate","100% of CMS IPPS rate",13043.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5776.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5776.59,16304.5,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",395,CDM,100,RC,,,Inpatient,,,,,,13641.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10913.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4409.42,100,,,,,0,"case rate","100% of CMS IPPS rate",10913.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3905.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3905.47,13641.94,
"APPENDIX PROCEDURES WITH MCC",397,CDM,100,RC,,,Inpatient,,,,,,29856.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23884.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17167.93,100,,,,,0,"case rate","100% of CMS IPPS rate",23884.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15205.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15205.81,29856.03,
"APPENDIX PROCEDURES WITH CC",398,CDM,100,RC,,,Inpatient,,,,,,21671.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17337.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10484.51,100,,,,,0,"case rate","100% of CMS IPPS rate",17337.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9286.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9286.24,21671.43,
"APPENDIX PROCEDURES WITHOUT CC/MCC",399,CDM,100,RC,,,Inpatient,,,,,,18245.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14596.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7786.47,100,,,,,0,"case rate","100% of CMS IPPS rate",14596.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6896.56,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6896.56,18245.48,
"SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL",402,CDM,100,RC,,,Inpatient,,,,,,44952.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35962.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27106.46,100,,,,,0,"case rate","100% of CMS IPPS rate",35962.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24008.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24008.47,44952.9,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,CDM,100,RC,,,Inpatient,,,,,,58418.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46735.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37613.83,100,,,,,0,"case rate","100% of CMS IPPS rate",46735.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33314.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33314.95,58418.99,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,CDM,100,RC,,,Inpatient,,,,,,34548.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27638.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19458.56,100,,,,,0,"case rate","100% of CMS IPPS rate",27638.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17234.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17234.65,34548.73,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,CDM,100,RC,,,Inpatient,,,,,,28228.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22582.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14798.32,100,,,,,0,"case rate","100% of CMS IPPS rate",22582.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13107.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13107.02,28228.04,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC",408,CDM,100,RC,,,Inpatient,,,,,,40728.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32582.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24259.46,100,,,,,0,"case rate","100% of CMS IPPS rate",32582.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21486.85,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21486.85,40728.28,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC",409,CDM,100,RC,,,Inpatient,,,,,,27835.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22268.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14526.02,100,,,,,0,"case rate","100% of CMS IPPS rate",22268.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12865.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12865.84,27835.19,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC",410,CDM,100,RC,,,Inpatient,,,,,,22359.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17887.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10747.11,100,,,,,0,"case rate","100% of CMS IPPS rate",17887.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9518.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9518.82,22359.6,
"CHOLECYSTECTOMY WITH C.D.E. WITH MCC",411,CDM,100,RC,,,Inpatient,,,,,,38292.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30633.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18800.33,100,,,,,0,"case rate","100% of CMS IPPS rate",30633.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16651.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16651.65,38292.3,
"CHOLECYSTECTOMY WITH C.D.E. WITH CC",412,CDM,100,RC,,,Inpatient,,,,,,27140.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21712.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14769.22,100,,,,,0,"case rate","100% of CMS IPPS rate",21712.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13081.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13081.25,27140.54,
"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC",413,CDM,100,RC,,,Inpatient,,,,,,23035.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18428.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11518.96,100,,,,,0,"case rate","100% of CMS IPPS rate",18428.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10202.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10202.46,23035.69,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC",414,CDM,100,RC,,,Inpatient,,,,,,40700.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32560.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24276.78,100,,,,,0,"case rate","100% of CMS IPPS rate",32560.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21502.19,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21502.19,40700.41,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC",415,CDM,100,RC,,,Inpatient,,,,,,26808.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21446.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13705.66,100,,,,,0,"case rate","100% of CMS IPPS rate",21446.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12139.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12139.24,26808.05,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC",416,CDM,100,RC,,,Inpatient,,,,,,20275.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16220.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9493.7,100,,,,,0,"case rate","100% of CMS IPPS rate",16220.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8408.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8408.67,20275.6,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC",417,CDM,100,RC,,,Inpatient,,,,,,29777.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23821.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16466.06,100,,,,,0,"case rate","100% of CMS IPPS rate",23821.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14584.15,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14584.15,29777.1,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC",418,CDM,100,RC,,,Inpatient,,,,,,23324.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18659.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11490.56,100,,,,,0,"case rate","100% of CMS IPPS rate",18659.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10177.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10177.3,23324.51,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC",419,CDM,100,RC,,,Inpatient,,,,,,20298.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16239.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9129.26,100,,,,,0,"case rate","100% of CMS IPPS rate",16239.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8085.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8085.87,20298.81,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC",420,CDM,100,RC,,,Inpatient,,,,,,39256.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31405.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24454.85,100,,,,,0,"case rate","100% of CMS IPPS rate",31405.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21659.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21659.91,39256.28,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC",421,CDM,100,RC,,,Inpatient,,,,,,23750.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19000.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11346.44,100,,,,,0,"case rate","100% of CMS IPPS rate",19000.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10049.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10049.66,23750.78,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC",422,CDM,100,RC,,,Inpatient,,,,,,20611.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16489.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10181.03,100,,,,,0,"case rate","100% of CMS IPPS rate",16489.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9017.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9017.44,20611.79,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC",423,CDM,100,RC,,,Inpatient,,,,,,46183.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36946.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28181.79,100,,,,,0,"case rate","100% of CMS IPPS rate",36946.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24960.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24960.9,46183.43,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC",424,CDM,100,RC,,,Inpatient,,,,,,27933.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22346.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15820.3,100,,,,,0,"case rate","100% of CMS IPPS rate",22346.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14012.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14012.2,27933.64,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC",425,CDM,100,RC,,,Inpatient,,,,,,21547.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17238.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10710.38,100,,,,,0,"case rate","100% of CMS IPPS rate",17238.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9486.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9486.3,21547.91,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",426,CDM,100,RC,,,Inpatient,,,,,,109968.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",87974.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",72580.9,100,,,,,0,"case rate","100% of CMS IPPS rate",87974.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",64285.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",64285.64,109968.09,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC",427,CDM,100,RC,,,Inpatient,,,,,,74653.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59722.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49212.48,100,,,,,0,"case rate","100% of CMS IPPS rate",59722.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",43587.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43587.99,74653.51,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC",428,CDM,100,RC,,,Inpatient,,,,,,59825.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47860.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38136.26,100,,,,,0,"case rate","100% of CMS IPPS rate",47860.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33777.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33777.67,59825.96,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC",429,CDM,100,RC,,,Inpatient,,,,,,91286.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",73029.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57789.52,100,,,,,0,"case rate","100% of CMS IPPS rate",73029.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",51184.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51184.76,91286.45,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC",430,CDM,100,RC,,,Inpatient,,,,,,61173.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48938.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37903.45,100,,,,,0,"case rate","100% of CMS IPPS rate",48938.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33571.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33571.47,61173.5,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC",432,CDM,100,RC,,,Inpatient,,,,,,25893.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20714.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13574.02,100,,,,,0,"case rate","100% of CMS IPPS rate",20714.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12022.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12022.64,25893.28,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC",433,CDM,100,RC,,,Inpatient,,,,,,17423.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13938.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7412.32,100,,,,,0,"case rate","100% of CMS IPPS rate",13938.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6565.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6565.17,17423.59,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC",434,CDM,100,RC,,,Inpatient,,,,,,14231.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11385.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4825.84,100,,,,,0,"case rate","100% of CMS IPPS rate",11385.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4274.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4274.3,14231.65,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC",435,CDM,100,RC,,,Inpatient,,,,,,24672.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19737.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12642.11,100,,,,,0,"case rate","100% of CMS IPPS rate",19737.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11197.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11197.24,24672.05,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC",436,CDM,100,RC,,,Inpatient,,,,,,18119.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14495.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7813.49,100,,,,,0,"case rate","100% of CMS IPPS rate",14495.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6920.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6920.49,18119.18,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC",437,CDM,100,RC,,,Inpatient,,,,,,15539.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12431.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5440.42,100,,,,,0,"case rate","100% of CMS IPPS rate",12431.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4818.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4818.63,15539.25,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC",438,CDM,100,RC,,,Inpatient,,,,,,22754.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18203.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11527.28,100,,,,,0,"case rate","100% of CMS IPPS rate",18203.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10209.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10209.83,22754.29,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC",439,CDM,100,RC,,,Inpatient,,,,,,15426.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12341.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5960.07,100,,,,,0,"case rate","100% of CMS IPPS rate",12341.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5278.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5278.89,15426.89,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC",440,CDM,100,RC,,,Inpatient,,,,,,13385.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10708.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4261.84,100,,,,,0,"case rate","100% of CMS IPPS rate",10708.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3774.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3774.76,13385.61,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,CDM,100,RC,,,Inpatient,,,,,,24281.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19425.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13098.01,100,,,,,0,"case rate","100% of CMS IPPS rate",19425.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11601.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11601.04,24281.99,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,CDM,100,RC,,,Inpatient,,,,,,16579.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13263.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6694.51,100,,,,,0,"case rate","100% of CMS IPPS rate",13263.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5929.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5929.4,16579.39,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,CDM,100,RC,,,Inpatient,,,,,,14112.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11290.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4868.8,100,,,,,0,"case rate","100% of CMS IPPS rate",11290.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4312.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4312.34,14112.8,
"DISORDERS OF THE BILIARY TRACT WITH MCC",444,CDM,100,RC,,,Inpatient,,,,,,23132.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18505.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11670.7,100,,,,,0,"case rate","100% of CMS IPPS rate",18505.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10336.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10336.86,23132.28,
"DISORDERS OF THE BILIARY TRACT WITH CC",445,CDM,100,RC,,,Inpatient,,,,,,17778.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14222.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7514.18,100,,,,,0,"case rate","100% of CMS IPPS rate",14222.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6655.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6655.38,17778.35,
"DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC",446,CDM,100,RC,,,Inpatient,,,,,,15297.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12238.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5524.25,100,,,,,0,"case rate","100% of CMS IPPS rate",12238.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4892.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4892.89,15297.8,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",447,CDM,100,RC,,,Inpatient,,,,,,69666.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",55733.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46454.85,100,,,,,0,"case rate","100% of CMS IPPS rate",55733.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",41145.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41145.54,69666.41,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",448,CDM,100,RC,,,Inpatient,,,,,,46998.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37599.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28293.35,100,,,,,0,"case rate","100% of CMS IPPS rate",37599.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25059.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25059.7,46998.83,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",450,CDM,100,RC,,,Inpatient,,,,,,57110.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45688.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35683.5,100,,,,,0,"case rate","100% of CMS IPPS rate",45688.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31605.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31605.24,57110.45,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",451,CDM,100,RC,,,Inpatient,,,,,,37615.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30092.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21381.97,100,,,,,0,"case rate","100% of CMS IPPS rate",30092.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18938.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18938.23,37615.26,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,CDM,100,RC,,,Inpatient,,,,,,85656.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",68525.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",58680.55,100,,,,,0,"case rate","100% of CMS IPPS rate",68525.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",51973.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51973.96,85656.7,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,CDM,100,RC,,,Inpatient,,,,,,62993.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50395,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39766.58,100,,,,,0,"case rate","100% of CMS IPPS rate",50395,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35221.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35221.66,62993.75,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,CDM,100,RC,,,Inpatient,,,,,,46365.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37092.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29918.13,100,,,,,0,"case rate","100% of CMS IPPS rate",37092.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26498.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26498.79,46365.45,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC",461,CDM,100,RC,,,Inpatient,,,,,,58906.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47125.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41508.46,100,,,,,0,"case rate","100% of CMS IPPS rate",47125.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36764.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36764.46,58906.55,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC",462,CDM,100,RC,,,Inpatient,,,,,,32318,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25854.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19842.41,100,,,,,0,"case rate","100% of CMS IPPS rate",25854.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17574.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17574.63,32318,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC",463,CDM,100,RC,,,Inpatient,,,,,,60545.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48436.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37421.91,100,,,,,0,"case rate","100% of CMS IPPS rate",48436.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33144.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33144.96,60545.7,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC",464,CDM,100,RC,,,Inpatient,,,,,,36540.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29232.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20429.96,100,,,,,0,"case rate","100% of CMS IPPS rate",29232.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18095.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18095.03,36540.76,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",465,CDM,100,RC,,,Inpatient,,,,,,24551.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19641.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12028.92,100,,,,,0,"case rate","100% of CMS IPPS rate",19641.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10654.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10654.13,24551.31,
"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC",466,CDM,100,RC,,,Inpatient,,,,,,55957,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44765.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35298.96,100,,,,,0,"case rate","100% of CMS IPPS rate",44765.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",31264.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31264.64,55957,
"REVISION OF HIP OR KNEE REPLACEMENT WITH CC",467,CDM,100,RC,,,Inpatient,,,,,,40366.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32292.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23732.18,100,,,,,0,"case rate","100% of CMS IPPS rate",32292.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21019.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21019.84,40366.09,
"REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC",468,CDM,100,RC,,,Inpatient,,,,,,33135.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26508.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18176.06,100,,,,,0,"case rate","100% of CMS IPPS rate",26508.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16098.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16098.72,33135.25,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT",469,CDM,100,RC,,,Inpatient,,,,,,35783.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28627.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22647.84,100,,,,,0,"case rate","100% of CMS IPPS rate",28627.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20059.42,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20059.42,35783.89,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC",470,CDM,100,RC,,,Inpatient,,,,,,25528.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20422.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13064.06,100,,,,,0,"case rate","100% of CMS IPPS rate",20422.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11570.97,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11570.97,25528.31,
"CERVICAL SPINAL FUSION WITH MCC",471,CDM,100,RC,,,Inpatient,,,,,,52458.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41966.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33654.77,100,,,,,0,"case rate","100% of CMS IPPS rate",41966.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29808.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29808.38,52458.61,
"CERVICAL SPINAL FUSION WITH CC",472,CDM,100,RC,,,Inpatient,,,,,,34975,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27980,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20073.83,100,,,,,0,"case rate","100% of CMS IPPS rate",27980,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17779.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17779.59,34975,
"CERVICAL SPINAL FUSION WITHOUT CC/MCC",473,CDM,100,RC,,,Inpatient,,,,,,30286.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24229.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16403,100,,,,,0,"case rate","100% of CMS IPPS rate",24229.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14528.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14528.31,30286.95,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC",474,CDM,100,RC,,,Inpatient,,,,,,47482.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37986.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31073.14,100,,,,,0,"case rate","100% of CMS IPPS rate",37986.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27521.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27521.8,47482.66,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC",475,CDM,100,RC,,,Inpatient,,,,,,28749.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22999.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14947.28,100,,,,,0,"case rate","100% of CMS IPPS rate",22999.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13238.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13238.96,28749.03,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",476,CDM,100,RC,,,Inpatient,,,,,,18575.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14860.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8058.77,100,,,,,0,"case rate","100% of CMS IPPS rate",14860.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7137.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7137.74,18575.16,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",477,CDM,100,RC,,,Inpatient,,,,,,39697.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31757.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23827.8,100,,,,,0,"case rate","100% of CMS IPPS rate",31757.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21104.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21104.52,39697.41,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",478,CDM,100,RC,,,Inpatient,,,,,,30453.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24362.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16203.46,100,,,,,0,"case rate","100% of CMS IPPS rate",24362.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14351.57,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14351.57,30453.18,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",479,CDM,100,RC,,,Inpatient,,,,,,24878.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19902.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12303.99,100,,,,,0,"case rate","100% of CMS IPPS rate",19902.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10897.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10897.76,24878.23,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC",480,CDM,100,RC,,,Inpatient,,,,,,34661.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27728.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20377.31,100,,,,,0,"case rate","100% of CMS IPPS rate",27728.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18048.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18048.39,34661.09,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC",481,CDM,100,RC,,,Inpatient,,,,,,27066.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21652.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14376.36,100,,,,,0,"case rate","100% of CMS IPPS rate",21652.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12733.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12733.29,27066.23,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC",482,CDM,100,RC,,,Inpatient,,,,,,22761.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18209.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10991.69,100,,,,,0,"case rate","100% of CMS IPPS rate",18209.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9735.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9735.45,22761.71,
"MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES",483,CDM,100,RC,,,Inpatient,,,,,,33357.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26685.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17655.71,100,,,,,0,"case rate","100% of CMS IPPS rate",26685.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15637.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15637.84,33357.21,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC",485,CDM,100,RC,,,Inpatient,,,,,,37584.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30067.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22305.56,100,,,,,0,"case rate","100% of CMS IPPS rate",30067.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19756.26,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19756.26,37584.63,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC",486,CDM,100,RC,,,Inpatient,,,,,,27034.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21627.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14695.08,100,,,,,0,"case rate","100% of CMS IPPS rate",21627.72,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13015.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13015.58,27034.65,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",487,CDM,100,RC,,,Inpatient,,,,,,22159.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17727.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10948.73,100,,,,,0,"case rate","100% of CMS IPPS rate",17727.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9697.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9697.4,22159.91,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC",488,CDM,100,RC,,,Inpatient,,,,,,24042.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19233.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13617.67,100,,,,,0,"case rate","100% of CMS IPPS rate",19233.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12061.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12061.31,24042.39,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",489,CDM,100,RC,,,Inpatient,,,,,,17986.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14389.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8580.5,100,,,,,0,"case rate","100% of CMS IPPS rate",14389.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7599.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7599.84,17986.38,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,CDM,100,RC,,,Inpatient,,,,,,41712.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33370.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24605.2,100,,,,,0,"case rate","100% of CMS IPPS rate",33370.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21793.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21793.08,41712.68,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,CDM,100,RC,,,Inpatient,,,,,,31167.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24933.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16635.81,100,,,,,0,"case rate","100% of CMS IPPS rate",24933.87,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14734.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14734.5,31167.34,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,CDM,100,RC,,,Inpatient,,,,,,26248.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20999.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13063.37,100,,,,,0,"case rate","100% of CMS IPPS rate",20999.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11570.36,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11570.36,26248.98,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC",495,CDM,100,RC,,,Inpatient,,,,,,41286.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33029.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24393.18,100,,,,,0,"case rate","100% of CMS IPPS rate",33029.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21605.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21605.29,41286.4,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC",496,CDM,100,RC,,,Inpatient,,,,,,24367.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19493.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13670.33,100,,,,,0,"case rate","100% of CMS IPPS rate",19493.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12107.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12107.95,24367.43,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC",497,CDM,100,RC,,,Inpatient,,,,,,18836.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15068.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9302.47,100,,,,,0,"case rate","100% of CMS IPPS rate",15068.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8239.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8239.29,18836.14,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC",498,CDM,100,RC,,,Inpatient,,,,,,35631.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28505.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17494.27,100,,,,,0,"case rate","100% of CMS IPPS rate",28505.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15494.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15494.86,35631.59,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC",499,CDM,100,RC,,,Inpatient,,,,,,26326.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21060.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7612.56,100,,,,,0,"case rate","100% of CMS IPPS rate",21060.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6742.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6742.52,26326.06,
"SOFT TISSUE PROCEDURES WITH MCC",500,CDM,100,RC,,,Inpatient,,,,,,37006.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29604.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21954.97,100,,,,,0,"case rate","100% of CMS IPPS rate",29604.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19445.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19445.74,37006.06,
"SOFT TISSUE PROCEDURES WITH CC",501,CDM,100,RC,,,Inpatient,,,,,,23849.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19079.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12365.65,100,,,,,0,"case rate","100% of CMS IPPS rate",19079.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10952.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10952.38,23849.23,
"SOFT TISSUE PROCEDURES WITHOUT CC/MCC",502,CDM,100,RC,,,Inpatient,,,,,,20114.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16091.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9680.78,100,,,,,0,"case rate","100% of CMS IPPS rate",16091.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8574.36,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8574.36,20114.01,
"FOOT PROCEDURES WITH MCC",503,CDM,100,RC,,,Inpatient,,,,,,33535.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26828.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18337.5,100,,,,,0,"case rate","100% of CMS IPPS rate",26828.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16241.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16241.71,33535.54,
"FOOT PROCEDURES WITH CC",504,CDM,100,RC,,,Inpatient,,,,,,24973.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19979.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12159.87,100,,,,,0,"case rate","100% of CMS IPPS rate",19979.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10770.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10770.12,24973.88,
"FOOT PROCEDURES WITHOUT CC/MCC",505,CDM,100,RC,,,Inpatient,,,,,,24264.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19411.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12159.87,100,,,,,0,"case rate","100% of CMS IPPS rate",19411.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10770.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10770.12,24264.35,
"MAJOR THUMB OR JOINT PROCEDURES",506,CDM,100,RC,,,Inpatient,,,,,,20144.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16115.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10386.81,100,,,,,0,"case rate","100% of CMS IPPS rate",16115.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9199.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9199.71,20144.68,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC",507,CDM,100,RC,,,Inpatient,,,,,,24390.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19512.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13429.21,100,,,,,0,"case rate","100% of CMS IPPS rate",19512.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11894.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11894.38,24390.66,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC",508,CDM,100,RC,,,Inpatient,,,,,,21678.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17343.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8601.98,100,,,,,0,"case rate","100% of CMS IPPS rate",17343.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7618.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7618.86,21678.85,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,CDM,100,RC,,,Inpatient,,,,,,35665.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28532.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19802.92,100,,,,,0,"case rate","100% of CMS IPPS rate",28532.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17539.65,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17539.65,35665.96,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,CDM,100,RC,,,Inpatient,,,,,,26925.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21540.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13588.57,100,,,,,0,"case rate","100% of CMS IPPS rate",21540.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12035.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12035.53,26925.99,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,CDM,100,RC,,,Inpatient,,,,,,22988.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18390.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11139.96,100,,,,,0,"case rate","100% of CMS IPPS rate",18390.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9866.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9866.78,22988.33,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,CDM,100,RC,,,Inpatient,,,,,,22235.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17788.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10431.85,100,,,,,0,"case rate","100% of CMS IPPS rate",17788.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9239.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9239.6,22235.16,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,CDM,100,RC,,,Inpatient,,,,,,17108.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13687,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7064.5,100,,,,,0,"case rate","100% of CMS IPPS rate",13687,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6257.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6257.1,17108.75,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC",515,CDM,100,RC,,,Inpatient,,,,,,37211.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29769.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21426.31,100,,,,,0,"case rate","100% of CMS IPPS rate",29769.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18977.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18977.5,37211.3,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC",516,CDM,100,RC,,,Inpatient,,,,,,26913.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21531.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13938.47,100,,,,,0,"case rate","100% of CMS IPPS rate",21531.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12345.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12345.44,26913.91,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC",517,CDM,100,RC,,,Inpatient,,,,,,21885.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17508.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10342.47,100,,,,,0,"case rate","100% of CMS IPPS rate",17508.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9160.43,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9160.43,21885.96,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR",518,CDM,100,RC,,,Inpatient,,,,,,42322.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33858.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24832.46,100,,,,,0,"case rate","100% of CMS IPPS rate",33858.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21994.36,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21994.36,42322.83,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC",519,CDM,100,RC,,,Inpatient,,,,,,26190.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20952.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13662.7,100,,,,,0,"case rate","100% of CMS IPPS rate",20952.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12101.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12101.2,26190.48,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC",520,CDM,100,RC,,,Inpatient,,,,,,21488.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17190.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9930.21,100,,,,,0,"case rate","100% of CMS IPPS rate",17190.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8795.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8795.29,21488.49,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC",521,CDM,100,RC,,,Inpatient,,,,,,34270.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27416.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20195.08,100,,,,,0,"case rate","100% of CMS IPPS rate",27416.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17886.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17886.99,34270.13,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC",522,CDM,100,RC,,,Inpatient,,,,,,27281.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21825.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14606.39,100,,,,,0,"case rate","100% of CMS IPPS rate",21825.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12937.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12937.03,27281.68,
"FRACTURES OF FEMUR WITH MCC",533,CDM,100,RC,,,Inpatient,,,,,,22173.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17739.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10565.57,100,,,,,0,"case rate","100% of CMS IPPS rate",17739.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9358.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9358.04,22173.85,
"FRACTURES OF FEMUR WITHOUT MCC",534,CDM,100,RC,,,Inpatient,,,,,,15100.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12080.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5639.96,100,,,,,0,"case rate","100% of CMS IPPS rate",12080.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4995.37,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4995.37,15100.91,
"FRACTURES OF HIP AND PELVIS WITH MCC",535,CDM,100,RC,,,Inpatient,,,,,,19520.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15616.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9214.48,100,,,,,0,"case rate","100% of CMS IPPS rate",15616.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8161.36,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8161.36,19520.56,
"FRACTURES OF HIP AND PELVIS WITHOUT MCC",536,CDM,100,RC,,,Inpatient,,,,,,15114.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12091.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5618.48,100,,,,,0,"case rate","100% of CMS IPPS rate",12091.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4976.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4976.35,15114.85,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,CDM,100,RC,,,Inpatient,,,,,,16477.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13181.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6367.48,100,,,,,0,"case rate","100% of CMS IPPS rate",13181.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5639.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5639.74,16477.24,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,CDM,100,RC,,,Inpatient,,,,,,14304.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11443.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4652.62,100,,,,,0,"case rate","100% of CMS IPPS rate",11443.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4120.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4120.87,14304.1,
"OSTEOMYELITIS WITH MCC",539,CDM,100,RC,,,Inpatient,,,,,,25907.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20725.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14012.6,100,,,,,0,"case rate","100% of CMS IPPS rate",20725.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12411.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12411.1,25907.23,
"OSTEOMYELITIS WITH CC",540,CDM,100,RC,,,Inpatient,,,,,,19653.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15722.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8966.43,100,,,,,0,"case rate","100% of CMS IPPS rate",15722.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7941.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7941.66,19653.38,
"OSTEOMYELITIS WITHOUT CC/MCC",541,CDM,100,RC,,,Inpatient,,,,,,14927.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11941.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6061.92,100,,,,,0,"case rate","100% of CMS IPPS rate",11941.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5369.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5369.1,14927.26,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC",542,CDM,100,RC,,,Inpatient,,,,,,24020.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19216.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12922.72,100,,,,,0,"case rate","100% of CMS IPPS rate",19216.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11445.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11445.78,24020.09,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC",543,CDM,100,RC,,,Inpatient,,,,,,17161.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13729.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7350.66,100,,,,,0,"case rate","100% of CMS IPPS rate",13729.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6510.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6510.55,17161.69,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC",544,CDM,100,RC,,,Inpatient,,,,,,14622.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11698.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5236.02,100,,,,,0,"case rate","100% of CMS IPPS rate",11698.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4637.59,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4637.59,14622.65,
"CONNECTIVE TISSUE DISORDERS WITH MCC",545,CDM,100,RC,,,Inpatient,,,,,,30662.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24529.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17508.13,100,,,,,0,"case rate","100% of CMS IPPS rate",24529.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15507.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15507.13,30662.13,
"CONNECTIVE TISSUE DISORDERS WITH CC",546,CDM,100,RC,,,Inpatient,,,,,,18326.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14661.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8021.36,100,,,,,0,"case rate","100% of CMS IPPS rate",14661.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7104.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7104.6,18326.29,
"CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",547,CDM,100,RC,,,Inpatient,,,,,,15380.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12304.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5170.2,100,,,,,0,"case rate","100% of CMS IPPS rate",12304.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4579.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4579.3,15380.45,
"SEPTIC ARTHRITIS WITH MCC",548,CDM,100,RC,,,Inpatient,,,,,,25546.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20437.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13958.56,100,,,,,0,"case rate","100% of CMS IPPS rate",20437.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12363.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12363.24,25546.89,
"SEPTIC ARTHRITIS WITH CC",549,CDM,100,RC,,,Inpatient,,,,,,18825.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15060.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8349.78,100,,,,,0,"case rate","100% of CMS IPPS rate",15060.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7395.48,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7395.48,18825.91,
"SEPTIC ARTHRITIS WITHOUT CC/MCC",550,CDM,100,RC,,,Inpatient,,,,,,15732.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12585.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5973.23,100,,,,,0,"case rate","100% of CMS IPPS rate",12585.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5290.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5290.55,15732.43,
"MEDICAL BACK PROBLEMS WITH MCC",551,CDM,100,RC,,,Inpatient,,,,,,23180.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18544.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11823.13,100,,,,,0,"case rate","100% of CMS IPPS rate",18544.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10471.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10471.87,23180.58,
"MEDICAL BACK PROBLEMS WITHOUT MCC",552,CDM,100,RC,,,Inpatient,,,,,,16542.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13233.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6677.88,100,,,,,0,"case rate","100% of CMS IPPS rate",13233.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5914.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5914.67,16542.24,
"BONE DISEASES AND ARTHROPATHIES WITH MCC",553,CDM,100,RC,,,Inpatient,,,,,,19653.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15722.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9048.88,100,,,,,0,"case rate","100% of CMS IPPS rate",15722.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8014.69,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8014.69,19653.38,
"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC",554,CDM,100,RC,,,Inpatient,,,,,,15323.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12259.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5782.69,100,,,,,0,"case rate","100% of CMS IPPS rate",12259.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5121.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5121.79,15323.8,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",555,CDM,100,RC,,,Inpatient,,,,,,19890.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15912.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9330.19,100,,,,,0,"case rate","100% of CMS IPPS rate",15912.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8263.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8263.84,19890.2,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC",556,CDM,100,RC,,,Inpatient,,,,,,15328.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12262.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5657.28,100,,,,,0,"case rate","100% of CMS IPPS rate",12262.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5010.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5010.71,15328.44,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,CDM,100,RC,,,Inpatient,,,,,,21423.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17138.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10737.41,100,,,,,0,"case rate","100% of CMS IPPS rate",17138.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9510.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9510.23,21423.48,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,CDM,100,RC,,,Inpatient,,,,,,15909.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12727.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5985.01,100,,,,,0,"case rate","100% of CMS IPPS rate",12727.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5300.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5300.99,15909.8,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,CDM,100,RC,,,Inpatient,,,,,,24933.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19947.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12861.75,100,,,,,0,"case rate","100% of CMS IPPS rate",19947.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11391.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11391.78,24933.94,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,CDM,100,RC,,,Inpatient,,,,,,18072.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14458.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7889.71,100,,,,,0,"case rate","100% of CMS IPPS rate",14458.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6988,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6988,18072.74,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,CDM,100,RC,,,Inpatient,,,,,,15080.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12064.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5664.91,100,,,,,0,"case rate","100% of CMS IPPS rate",12064.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5017.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5017.46,15080.49,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,CDM,100,RC,,,Inpatient,,,,,,20846.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16677.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10140.15,100,,,,,0,"case rate","100% of CMS IPPS rate",16677.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8981.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8981.24,20846.75,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,CDM,100,RC,,,Inpatient,,,,,,15931.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12744.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6192.87,100,,,,,0,"case rate","100% of CMS IPPS rate",12744.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5485.09,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5485.09,15931.16,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC",564,CDM,100,RC,,,Inpatient,,,,,,21950.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17560.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10872.52,100,,,,,0,"case rate","100% of CMS IPPS rate",17560.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9629.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9629.9,21950.04,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC",565,CDM,100,RC,,,Inpatient,,,,,,16663.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13331.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7065.2,100,,,,,0,"case rate","100% of CMS IPPS rate",13331.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6257.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6257.72,16663.93,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC",566,CDM,100,RC,,,Inpatient,,,,,,14573.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11658.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5183.36,100,,,,,0,"case rate","100% of CMS IPPS rate",11658.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4590.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4590.96,14573.41,
"SKIN DEBRIDEMENT WITH MCC",570,CDM,100,RC,,,Inpatient,,,,,,34928.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27942.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20856.77,100,,,,,0,"case rate","100% of CMS IPPS rate",27942.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18473.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18473.06,34928.56,
"SKIN DEBRIDEMENT WITH CC",571,CDM,100,RC,,,Inpatient,,,,,,23305.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18644.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11600.72,100,,,,,0,"case rate","100% of CMS IPPS rate",18644.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10274.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10274.88,23305.01,
"SKIN DEBRIDEMENT WITHOUT CC/MCC",572,CDM,100,RC,,,Inpatient,,,,,,18260.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14608.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7915.35,100,,,,,0,"case rate","100% of CMS IPPS rate",14608.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7010.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7010.7,18260.34,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC",573,CDM,100,RC,,,Inpatient,,,,,,68457.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",54765.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42668.32,100,,,,,0,"case rate","100% of CMS IPPS rate",54765.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",37791.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37791.76,68457.26,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC",574,CDM,100,RC,,,Inpatient,,,,,,39853.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31882.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24007.25,100,,,,,0,"case rate","100% of CMS IPPS rate",31882.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21263.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21263.47,39853.44,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",575,CDM,100,RC,,,Inpatient,,,,,,24303.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19442.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13834.54,100,,,,,0,"case rate","100% of CMS IPPS rate",19442.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12253.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12253.39,24303.35,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC",576,CDM,100,RC,,,Inpatient,,,,,,53131.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42505.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37382.42,100,,,,,0,"case rate","100% of CMS IPPS rate",42505.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33109.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33109.98,53131.93,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC",577,CDM,100,RC,,,Inpatient,,,,,,32231.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25785.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18449.74,100,,,,,0,"case rate","100% of CMS IPPS rate",25785.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16341.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16341.12,32231.63,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",578,CDM,100,RC,,,Inpatient,,,,,,22533.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18026.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11712.27,100,,,,,0,"case rate","100% of CMS IPPS rate",18026.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10373.68,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10373.68,22533.26,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,CDM,100,RC,,,Inpatient,,,,,,37690.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30152.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22583.4,100,,,,,0,"case rate","100% of CMS IPPS rate",30152.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",20002.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20002.35,37690.51,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,CDM,100,RC,,,Inpatient,,,,,,23662.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18930.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12284.59,100,,,,,0,"case rate","100% of CMS IPPS rate",18930.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10880.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10880.58,23662.55,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,CDM,100,RC,,,Inpatient,,,,,,21016.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16813.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9971.79,100,,,,,0,"case rate","100% of CMS IPPS rate",16813.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8832.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8832.11,21016.71,
"MASTECTOMY FOR MALIGNANCY WITH CC/MCC",582,CDM,100,RC,,,Inpatient,,,,,,25506.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20405.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12133.54,100,,,,,0,"case rate","100% of CMS IPPS rate",20405.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10746.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10746.8,25506.96,
"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC",583,CDM,100,RC,,,Inpatient,,,,,,23629.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18903.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11381.78,100,,,,,0,"case rate","100% of CMS IPPS rate",18903.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10080.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10080.95,23629.13,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,CDM,100,RC,,,Inpatient,,,,,,27495.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21996.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14185.82,100,,,,,0,"case rate","100% of CMS IPPS rate",21996.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12564.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12564.53,27495.28,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,CDM,100,RC,,,Inpatient,,,,,,25530.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20424.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13754.16,100,,,,,0,"case rate","100% of CMS IPPS rate",20424.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12182.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12182.2,25530.16,
"SKIN ULCERS WITH MCC",592,CDM,100,RC,,,Inpatient,,,,,,25587.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20470.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14247.49,100,,,,,0,"case rate","100% of CMS IPPS rate",20470.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12619.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12619.14,25587.74,
"SKIN ULCERS WITH CC",593,CDM,100,RC,,,Inpatient,,,,,,18631.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14905.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8471.72,100,,,,,0,"case rate","100% of CMS IPPS rate",14905.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7503.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7503.49,18631.83,
"SKIN ULCERS WITHOUT CC/MCC",594,CDM,100,RC,,,Inpatient,,,,,,15664.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12531.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5880.39,100,,,,,0,"case rate","100% of CMS IPPS rate",12531.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5208.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5208.32,15664.64,
"MAJOR SKIN DISORDERS WITH MCC",595,CDM,100,RC,,,Inpatient,,,,,,27309.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21847.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14654.89,100,,,,,0,"case rate","100% of CMS IPPS rate",21847.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12979.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12979.99,27309.55,
"MAJOR SKIN DISORDERS WITHOUT MCC",596,CDM,100,RC,,,Inpatient,,,,,,17667.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14134.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7490.62,100,,,,,0,"case rate","100% of CMS IPPS rate",14134.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6634.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6634.52,17667.83,
"MALIGNANT BREAST DISORDERS WITH MCC",597,CDM,100,RC,,,Inpatient,,,,,,23096.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18477.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12171.65,100,,,,,0,"case rate","100% of CMS IPPS rate",18477.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10780.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10780.55,23096.98,
"MALIGNANT BREAST DISORDERS WITH CC",598,CDM,100,RC,,,Inpatient,,,,,,18121.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14496.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7349.96,100,,,,,0,"case rate","100% of CMS IPPS rate",14496.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6509.94,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6509.94,18121.04,
"MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",599,CDM,100,RC,,,Inpatient,,,,,,14760.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11808.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5923.35,100,,,,,0,"case rate","100% of CMS IPPS rate",11808.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5246.37,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5246.37,14760.09,
"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC",600,CDM,100,RC,,,Inpatient,,,,,,17288,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13830.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6627.99,100,,,,,0,"case rate","100% of CMS IPPS rate",13830.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5870.48,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5870.48,17288,
"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",601,CDM,100,RC,,,Inpatient,,,,,,13233.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10586.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4153.76,100,,,,,0,"case rate","100% of CMS IPPS rate",10586.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3679.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3679.02,13233.31,
"CELLULITIS WITH MCC",602,CDM,100,RC,,,Inpatient,,,,,,20814.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16651.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10179.65,100,,,,,0,"case rate","100% of CMS IPPS rate",16651.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9016.22,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9016.22,20814.24,
"CELLULITIS WITHOUT MCC",603,CDM,100,RC,,,Inpatient,,,,,,15702.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12562.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6102.8,100,,,,,0,"case rate","100% of CMS IPPS rate",12562.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5405.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5405.31,15702.71,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,CDM,100,RC,,,Inpatient,,,,,,21286.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17028.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10293.97,100,,,,,0,"case rate","100% of CMS IPPS rate",17028.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9117.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9117.47,21286.04,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,CDM,100,RC,,,Inpatient,,,,,,16121.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12897.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6400.04,100,,,,,0,"case rate","100% of CMS IPPS rate",12897.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5668.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5668.58,16121.54,
"MINOR SKIN DISORDERS WITH MCC",606,CDM,100,RC,,,Inpatient,,,,,,21667.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17334.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11157.29,100,,,,,0,"case rate","100% of CMS IPPS rate",17334.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9882.12,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9882.12,21667.73,
"MINOR SKIN DISORDERS WITHOUT MCC",607,CDM,100,RC,,,Inpatient,,,,,,16032.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12825.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5987.78,100,,,,,0,"case rate","100% of CMS IPPS rate",12825.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5303.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5303.44,16032.4,
"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC",614,CDM,100,RC,,,Inpatient,,,,,,27969.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22375.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15790.51,100,,,,,0,"case rate","100% of CMS IPPS rate",22375.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13985.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13985.81,27969.85,
"ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC",615,CDM,100,RC,,,Inpatient,,,,,,20609.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16487.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9928.83,100,,,,,0,"case rate","100% of CMS IPPS rate",16487.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8794.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8794.06,20609.94,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,CDM,100,RC,,,Inpatient,,,,,,40002.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32001.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26779.43,100,,,,,0,"case rate","100% of CMS IPPS rate",32001.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23718.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23718.81,40002.03,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,CDM,100,RC,,,Inpatient,,,,,,24984.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19987.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13383.48,100,,,,,0,"case rate","100% of CMS IPPS rate",19987.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11853.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11853.88,24984.1,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,CDM,100,RC,,,Inpatient,,,,,,20786.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16629.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8626.92,100,,,,,0,"case rate","100% of CMS IPPS rate",16629.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7640.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7640.95,20786.39,
"O.R. PROCEDURES FOR OBESITY WITH MCC",619,CDM,100,RC,,,Inpatient,,,,,,34429.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27543.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18891.1,100,,,,,0,"case rate","100% of CMS IPPS rate",27543.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16732.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16732.04,34429.85,
"O.R. PROCEDURES FOR OBESITY WITH CC",620,CDM,100,RC,,,Inpatient,,,,,,22476.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17981.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11065.13,100,,,,,0,"case rate","100% of CMS IPPS rate",17981.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9800.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9800.5,22476.61,
"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC",621,CDM,100,RC,,,Inpatient,,,,,,21623.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17298.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10128.37,100,,,,,0,"case rate","100% of CMS IPPS rate",17298.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8970.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8970.8,21623.14,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,CDM,100,RC,,,Inpatient,,,,,,40668.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32535.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25927.2,100,,,,,0,"case rate","100% of CMS IPPS rate",32535.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",22963.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22963.98,40668.84,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,CDM,100,RC,,,Inpatient,,,,,,24274.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19419.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13253.22,100,,,,,0,"case rate","100% of CMS IPPS rate",19419.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11738.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11738.51,24274.56,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,CDM,100,RC,,,Inpatient,,,,,,19241.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15392.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6900.29,100,,,,,0,"case rate","100% of CMS IPPS rate",15392.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6111.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6111.66,19241.03,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,CDM,100,RC,,,Inpatient,,,,,,35662.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28529.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19865.28,100,,,,,0,"case rate","100% of CMS IPPS rate",28529.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17594.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17594.88,35662.24,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,CDM,100,RC,,,Inpatient,,,,,,21539.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17231.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10457.49,100,,,,,0,"case rate","100% of CMS IPPS rate",17231.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9262.3,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9262.3,21539.56,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,CDM,100,RC,,,Inpatient,,,,,,19950.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15960.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8777.97,100,,,,,0,"case rate","100% of CMS IPPS rate",15960.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7774.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7774.74,19950.56,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,CDM,100,RC,,,Inpatient,,,,,,42225.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33780.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27338.57,100,,,,,0,"case rate","100% of CMS IPPS rate",33780.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24214.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24214.05,42225.33,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,CDM,100,RC,,,Inpatient,,,,,,27849.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22279.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15583.34,100,,,,,0,"case rate","100% of CMS IPPS rate",22279.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13802.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13802.32,27849.11,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,CDM,100,RC,,,Inpatient,,,,,,21169.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16935.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9709.19,100,,,,,0,"case rate","100% of CMS IPPS rate",16935.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8599.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8599.53,21169.01,
"DIABETES WITH MCC",637,CDM,100,RC,,,Inpatient,,,,,,20957.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16765.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10090.27,100,,,,,0,"case rate","100% of CMS IPPS rate",16765.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8937.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8937.05,20957.28,
"DIABETES WITH CC",638,CDM,100,RC,,,Inpatient,,,,,,15937.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12750.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6355,100,,,,,0,"case rate","100% of CMS IPPS rate",12750.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5628.69,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5628.69,15937.68,
"DIABETES WITHOUT CC/MCC",639,CDM,100,RC,,,Inpatient,,,,,,13383.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10707,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4341.52,100,,,,,0,"case rate","100% of CMS IPPS rate",10707,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3845.33,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3845.33,13383.75,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,CDM,100,RC,,,Inpatient,,,,,,20018.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16014.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9201.31,100,,,,,0,"case rate","100% of CMS IPPS rate",16014.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8149.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8149.7,20018.35,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,CDM,100,RC,,,Inpatient,,,,,,14841.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11873.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5414.09,100,,,,,0,"case rate","100% of CMS IPPS rate",11873.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4795.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4795.31,14841.8,
"INBORN AND OTHER DISORDERS OF METABOLISM",642,CDM,100,RC,,,Inpatient,,,,,,20821.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16657.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8599.21,100,,,,,0,"case rate","100% of CMS IPPS rate",16657.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7616.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7616.41,20821.66,
"ENDOCRINE DISORDERS WITH MCC",643,CDM,100,RC,,,Inpatient,,,,,,22901.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18321.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11482.93,100,,,,,0,"case rate","100% of CMS IPPS rate",18321.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10170.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10170.55,22901.96,
"ENDOCRINE DISORDERS WITH CC",644,CDM,100,RC,,,Inpatient,,,,,,17133.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13707.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7160.12,100,,,,,0,"case rate","100% of CMS IPPS rate",13707.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6341.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6341.79,17133.83,
"ENDOCRINE DISORDERS WITHOUT CC/MCC",645,CDM,100,RC,,,Inpatient,,,,,,14749.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11799.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5395.38,100,,,,,0,"case rate","100% of CMS IPPS rate",11799.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4778.74,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4778.74,14749.86,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC",650,CDM,100,RC,,,Inpatient,,,,,,51276.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41021.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31922.6,100,,,,,0,"case rate","100% of CMS IPPS rate",41021.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28274.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28274.17,51276.39,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC",651,CDM,100,RC,,,Inpatient,,,,,,42030.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33624.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24059.91,100,,,,,0,"case rate","100% of CMS IPPS rate",33624.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21310.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21310.11,42030.3,
"KIDNEY TRANSPLANT",652,CDM,100,RC,,,Inpatient,,,,,,37606.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30085.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21280.81,100,,,,,0,"case rate","100% of CMS IPPS rate",30085.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18848.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18848.63,37606.91,
"MAJOR BLADDER PROCEDURES WITH MCC",653,CDM,100,RC,,,Inpatient,,,,,,55873.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",44698.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38624.73,100,,,,,0,"case rate","100% of CMS IPPS rate",44698.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",34210.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34210.32,55873.45,
"MAJOR BLADDER PROCEDURES WITH CC",654,CDM,100,RC,,,Inpatient,,,,,,33611.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26889.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19553.48,100,,,,,0,"case rate","100% of CMS IPPS rate",26889.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17318.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17318.72,33611.66,
"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC",655,CDM,100,RC,,,Inpatient,,,,,,27271.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21817.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14392.99,100,,,,,0,"case rate","100% of CMS IPPS rate",21817.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12748.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12748.02,27271.48,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC",656,CDM,100,RC,,,Inpatient,,,,,,37182.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29746.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22573.7,100,,,,,0,"case rate","100% of CMS IPPS rate",29746.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19993.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19993.76,37182.51,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC",657,CDM,100,RC,,,Inpatient,,,,,,24609.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19687.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12666.36,100,,,,,0,"case rate","100% of CMS IPPS rate",19687.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11218.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11218.72,24609.83,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC",658,CDM,100,RC,,,Inpatient,,,,,,22026.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17620.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10420.76,100,,,,,0,"case rate","100% of CMS IPPS rate",17620.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9229.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9229.78,22026.2,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC",659,CDM,100,RC,,,Inpatient,,,,,,31211.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24969.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17905.84,100,,,,,0,"case rate","100% of CMS IPPS rate",24969.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15859.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15859.38,31211.91,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC",660,CDM,100,RC,,,Inpatient,,,,,,19889.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15911.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9284.46,100,,,,,0,"case rate","100% of CMS IPPS rate",15911.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8223.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8223.34,19889.28,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC",661,CDM,100,RC,,,Inpatient,,,,,,17230.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13784.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7113,100,,,,,0,"case rate","100% of CMS IPPS rate",13784.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6300.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6300.06,17230.41,
"MINOR BLADDER PROCEDURES WITH MCC",662,CDM,100,RC,,,Inpatient,,,,,,36046.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28837.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21614.77,100,,,,,0,"case rate","100% of CMS IPPS rate",28837.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19144.42,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19144.42,36046.71,
"MINOR BLADDER PROCEDURES WITH CC",663,CDM,100,RC,,,Inpatient,,,,,,21732.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17386.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10582.9,100,,,,,0,"case rate","100% of CMS IPPS rate",17386.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9373.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9373.38,21732.73,
"MINOR BLADDER PROCEDURES WITHOUT CC/MCC",664,CDM,100,RC,,,Inpatient,,,,,,17337.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13869.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7481.61,100,,,,,0,"case rate","100% of CMS IPPS rate",13869.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6626.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6626.54,17337.21,
"PROSTATECTOMY WITH MCC",665,CDM,100,RC,,,Inpatient,,,,,,36601.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29280.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23790.38,100,,,,,0,"case rate","100% of CMS IPPS rate",29280.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21071.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21071.39,36601.15,
"PROSTATECTOMY WITH CC",666,CDM,100,RC,,,Inpatient,,,,,,23860.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19088.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11413.65,100,,,,,0,"case rate","100% of CMS IPPS rate",19088.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10109.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10109.18,23860.36,
"PROSTATECTOMY WITHOUT CC/MCC",667,CDM,100,RC,,,Inpatient,,,,,,17887.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14310.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7121.32,100,,,,,0,"case rate","100% of CMS IPPS rate",14310.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6307.42,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6307.42,17887.93,
"TRANSURETHRAL PROCEDURES WITH MCC",668,CDM,100,RC,,,Inpatient,,,,,,34732.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27786.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20206.17,100,,,,,0,"case rate","100% of CMS IPPS rate",27786.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17896.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17896.81,34732.6,
"TRANSURETHRAL PROCEDURES WITH CC",669,CDM,100,RC,,,Inpatient,,,,,,22028.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17622.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10722.16,100,,,,,0,"case rate","100% of CMS IPPS rate",17622.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9496.73,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9496.73,22028.05,
"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC",670,CDM,100,RC,,,Inpatient,,,,,,16690.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13352.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6621.76,100,,,,,0,"case rate","100% of CMS IPPS rate",13352.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5864.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5864.96,16690.85,
"URETHRAL PROCEDURES WITH CC/MCC",671,CDM,100,RC,,,Inpatient,,,,,,24284.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19427.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11943,100,,,,,0,"case rate","100% of CMS IPPS rate",19427.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10578.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10578.04,24284.78,
"URETHRAL PROCEDURES WITHOUT CC/MCC",672,CDM,100,RC,,,Inpatient,,,,,,17639.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14111.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7582.77,100,,,,,0,"case rate","100% of CMS IPPS rate",14111.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6716.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6716.14,17639.96,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC",673,CDM,100,RC,,,Inpatient,,,,,,46634.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37307.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29028.48,100,,,,,0,"case rate","100% of CMS IPPS rate",37307.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25710.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25710.82,46634.78,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC",674,CDM,100,RC,,,Inpatient,,,,,,29333.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23466.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15994.21,100,,,,,0,"case rate","100% of CMS IPPS rate",23466.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14166.24,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14166.24,29333.16,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC",675,CDM,100,RC,,,Inpatient,,,,,,22858.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18286.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10845.49,100,,,,,0,"case rate","100% of CMS IPPS rate",18286.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9605.96,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9605.96,22858.31,
"RENAL FAILURE WITH MCC",682,CDM,100,RC,,,Inpatient,,,,,,21368.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17094.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10406.21,100,,,,,0,"case rate","100% of CMS IPPS rate",17094.94,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9216.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9216.89,21368.68,
"RENAL FAILURE WITH CC",683,CDM,100,RC,,,Inpatient,,,,,,15748.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12598.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6158.92,100,,,,,0,"case rate","100% of CMS IPPS rate",12598.57,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5455.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5455.02,15748.21,
"RENAL FAILURE WITHOUT CC/MCC",684,CDM,100,RC,,,Inpatient,,,,,,13189.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10551.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4208.49,100,,,,,0,"case rate","100% of CMS IPPS rate",10551.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3727.5,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3727.5,13189.66,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC",686,CDM,100,RC,,,Inpatient,,,,,,24365.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19492.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13065.45,100,,,,,0,"case rate","100% of CMS IPPS rate",19492.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11572.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11572.2,24365.59,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH CC",687,CDM,100,RC,,,Inpatient,,,,,,17345.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13876.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7293.84,100,,,,,0,"case rate","100% of CMS IPPS rate",13876.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6460.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6460.23,17345.56,
"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC",688,CDM,100,RC,,,Inpatient,,,,,,14954.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11963.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5017.76,100,,,,,0,"case rate","100% of CMS IPPS rate",11963.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4444.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4444.29,14954.18,
"KIDNEY AND URINARY TRACT INFECTIONS WITH MCC",689,CDM,100,RC,,,Inpatient,,,,,,18390.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14712.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8108.66,100,,,,,0,"case rate","100% of CMS IPPS rate",14712.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7181.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7181.92,18390.35,
"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC",690,CDM,100,RC,,,Inpatient,,,,,,15132.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12105.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5560.97,100,,,,,0,"case rate","100% of CMS IPPS rate",12105.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4925.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4925.41,15132.49,
"URINARY STONES WITH MCC",693,CDM,100,RC,,,Inpatient,,,,,,20101.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16080.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10187.96,100,,,,,0,"case rate","100% of CMS IPPS rate",16080.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9023.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9023.58,20101.01,
"URINARY STONES WITHOUT MCC",694,CDM,100,RC,,,Inpatient,,,,,,14874.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11899.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5414.09,100,,,,,0,"case rate","100% of CMS IPPS rate",11899.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4795.31,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4795.31,14874.31,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC",695,CDM,100,RC,,,Inpatient,,,,,,18237.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14589.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7814.19,100,,,,,0,"case rate","100% of CMS IPPS rate",14589.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6921.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6921.11,18237.11,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC",696,CDM,100,RC,,,Inpatient,,,,,,14013.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11210.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4793.27,100,,,,,0,"case rate","100% of CMS IPPS rate",11210.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4245.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4245.45,14013.41,
"URETHRAL STRICTURE",697,CDM,100,RC,,,Inpatient,,,,,,17624.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14099.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6740.24,100,,,,,0,"case rate","100% of CMS IPPS rate",14099.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5969.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5969.9,17624.16,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC",698,CDM,100,RC,,,Inpatient,,,,,,22979.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18383.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11646.45,100,,,,,0,"case rate","100% of CMS IPPS rate",18383.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10315.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10315.38,22979.04,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC",699,CDM,100,RC,,,Inpatient,,,,,,17040.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13632.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7066.58,100,,,,,0,"case rate","100% of CMS IPPS rate",13632.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6258.94,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6258.94,17040.98,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC",700,CDM,100,RC,,,Inpatient,,,,,,14021.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11217.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4809.9,100,,,,,0,"case rate","100% of CMS IPPS rate",11217.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4260.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4260.18,14021.78,
"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC",707,CDM,100,RC,,,Inpatient,,,,,,26191.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20953.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13445.84,100,,,,,0,"case rate","100% of CMS IPPS rate",20953.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11909.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11909.11,26191.39,
"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC",708,CDM,100,RC,,,Inpatient,,,,,,21862.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17490.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10271.8,100,,,,,0,"case rate","100% of CMS IPPS rate",17490.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9097.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9097.84,21862.74,
"PENIS PROCEDURES WITH CC/MCC",709,CDM,100,RC,,,Inpatient,,,,,,29226.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23381.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15569.48,100,,,,,0,"case rate","100% of CMS IPPS rate",23381.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13790.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13790.05,29226.38,
"PENIS PROCEDURES WITHOUT CC/MCC",710,CDM,100,RC,,,Inpatient,,,,,,20627.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16502.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10402.75,100,,,,,0,"case rate","100% of CMS IPPS rate",16502.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9213.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9213.82,20627.58,
"TESTES PROCEDURES WITH CC/MCC",711,CDM,100,RC,,,Inpatient,,,,,,26966.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21573.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13217.19,100,,,,,0,"case rate","100% of CMS IPPS rate",21573.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11706.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11706.6,26966.85,
"TESTES PROCEDURES WITHOUT CC/MCC",712,CDM,100,RC,,,Inpatient,,,,,,17827.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14262.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6139.52,100,,,,,0,"case rate","100% of CMS IPPS rate",14262.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5437.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5437.84,17827.56,
"TRANSURETHRAL PROSTATECTOMY WITH CC/MCC",713,CDM,100,RC,,,Inpatient,,,,,,21576.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17261.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10018.9,100,,,,,0,"case rate","100% of CMS IPPS rate",17261.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8873.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8873.84,21576.73,
"TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC",714,CDM,100,RC,,,Inpatient,,,,,,17434.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13947.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6510.9,100,,,,,0,"case rate","100% of CMS IPPS rate",13947.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5766.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5766.77,17434.73,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC",715,CDM,100,RC,,,Inpatient,,,,,,28392.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22713.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15647.08,100,,,,,0,"case rate","100% of CMS IPPS rate",22713.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13858.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13858.78,28392.41,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC",716,CDM,100,RC,,,Inpatient,,,,,,21275.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17020.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9833.9,100,,,,,0,"case rate","100% of CMS IPPS rate",17020.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8709.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8709.99,21275.81,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC",717,CDM,100,RC,,,Inpatient,,,,,,25171.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20137.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12856.2,100,,,,,0,"case rate","100% of CMS IPPS rate",20137.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11386.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11386.87,25171.69,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC",718,CDM,100,RC,,,Inpatient,,,,,,20088,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16070.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8535.47,100,,,,,0,"case rate","100% of CMS IPPS rate",16070.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7559.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7559.95,20088,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,CDM,100,RC,,,Inpatient,,,,,,24421.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19537.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11979.03,100,,,,,0,"case rate","100% of CMS IPPS rate",19537.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10609.95,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10609.95,24421.3,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,CDM,100,RC,,,Inpatient,,,,,,18226.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14581.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7780.24,100,,,,,0,"case rate","100% of CMS IPPS rate",14581.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6891.04,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6891.04,18226.91,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,CDM,100,RC,,,Inpatient,,,,,,13704.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10963.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4551.46,100,,,,,0,"case rate","100% of CMS IPPS rate",10963.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4031.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4031.28,13704.16,
"BENIGN PROSTATIC HYPERTROPHY WITH MCC",725,CDM,100,RC,,,Inpatient,,,,,,18482.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14785.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8748.18,100,,,,,0,"case rate","100% of CMS IPPS rate",14785.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7748.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7748.35,18482.29,
"BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC",726,CDM,100,RC,,,Inpatient,,,,,,14319.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11455.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5157.72,100,,,,,0,"case rate","100% of CMS IPPS rate",11455.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4568.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4568.25,14319.88,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC",727,CDM,100,RC,,,Inpatient,,,,,,21386.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17109.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10181.03,100,,,,,0,"case rate","100% of CMS IPPS rate",17109.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9017.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9017.44,21386.33,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC",728,CDM,100,RC,,,Inpatient,,,,,,15148.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12118.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5661.44,100,,,,,0,"case rate","100% of CMS IPPS rate",12118.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5014.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5014.4,15148.29,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC",729,CDM,100,RC,,,Inpatient,,,,,,17446.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13957.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7627.81,100,,,,,0,"case rate","100% of CMS IPPS rate",13957.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6756.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6756.03,17446.8,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",730,CDM,100,RC,,,Inpatient,,,,,,13855.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11084.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4205.03,100,,,,,0,"case rate","100% of CMS IPPS rate",11084.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3724.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3724.44,13855.54,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,CDM,100,RC,,,Inpatient,,,,,,27395.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21916.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14569.67,100,,,,,0,"case rate","100% of CMS IPPS rate",21916.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12904.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12904.51,27395.91,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,CDM,100,RC,,,Inpatient,,,,,,20110.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16088.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8410.75,100,,,,,0,"case rate","100% of CMS IPPS rate",16088.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7449.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7449.49,20110.29,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC",736,CDM,100,RC,,,Inpatient,,,,,,40810.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32648.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27282.45,100,,,,,0,"case rate","100% of CMS IPPS rate",32648.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24164.34,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24164.34,40810.91,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC",737,CDM,100,RC,,,Inpatient,,,,,,26751.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21401.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13846.31,100,,,,,0,"case rate","100% of CMS IPPS rate",21401.12,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12263.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12263.82,26751.4,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC",738,CDM,100,RC,,,Inpatient,,,,,,21252.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17002.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10510.15,100,,,,,0,"case rate","100% of CMS IPPS rate",17002.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9308.94,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9308.94,21252.6,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC",739,CDM,100,RC,,,Inpatient,,,,,,40888,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32710.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27582.46,100,,,,,0,"case rate","100% of CMS IPPS rate",32710.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24430.07,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24430.07,40888,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC",740,CDM,100,RC,,,Inpatient,,,,,,24420.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19536.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12598.46,100,,,,,0,"case rate","100% of CMS IPPS rate",19536.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11158.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11158.58,24420.38,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC",741,CDM,100,RC,,,Inpatient,,,,,,20858.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16687.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9517.26,100,,,,,0,"case rate","100% of CMS IPPS rate",16687.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8429.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8429.54,20858.83,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC",742,CDM,100,RC,,,Inpatient,,,,,,24654.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19723.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12656.66,100,,,,,0,"case rate","100% of CMS IPPS rate",19723.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11210.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11210.13,24654.41,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC",743,CDM,100,RC,,,Inpatient,,,,,,19137.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15309.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8305.43,100,,,,,0,"case rate","100% of CMS IPPS rate",15309.62,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7356.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7356.21,19137.03,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,CDM,100,RC,,,Inpatient,,,,,,26644.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21315.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13538.68,100,,,,,0,"case rate","100% of CMS IPPS rate",21315.67,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11991.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11991.35,26644.59,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,CDM,100,RC,,,Inpatient,,,,,,18178.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14542.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7100.53,100,,,,,0,"case rate","100% of CMS IPPS rate",14542.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6289.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6289.01,18178.6,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,CDM,100,RC,,,Inpatient,,,,,,23747.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18997.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11602.8,100,,,,,0,"case rate","100% of CMS IPPS rate",18997.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10276.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10276.72,23747.06,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,CDM,100,RC,,,Inpatient,,,,,,15598.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12478.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6618.29,100,,,,,0,"case rate","100% of CMS IPPS rate",12478.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5861.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5861.89,15598.69,
"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES",748,CDM,100,RC,,,Inpatient,,,,,,20498.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16398.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9438.97,100,,,,,0,"case rate","100% of CMS IPPS rate",16398.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8360.19,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8360.19,20498.5,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC",749,CDM,100,RC,,,Inpatient,,,,,,31459.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25167.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17935.63,100,,,,,0,"case rate","100% of CMS IPPS rate",25167.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15885.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15885.77,31459.88,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",750,CDM,100,RC,,,Inpatient,,,,,,21320.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17056.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8934.56,100,,,,,0,"case rate","100% of CMS IPPS rate",17056.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7913.43,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7913.43,21320.39,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,CDM,100,RC,,,Inpatient,,,,,,24718.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19774.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12536.1,100,,,,,0,"case rate","100% of CMS IPPS rate",19774.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11103.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11103.35,24718.49,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,CDM,100,RC,,,Inpatient,,,,,,17717.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14173.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7691.55,100,,,,,0,"case rate","100% of CMS IPPS rate",14173.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6812.48,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6812.48,17717.05,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,CDM,100,RC,,,Inpatient,,,,,,16534.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13227.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6616.91,100,,,,,0,"case rate","100% of CMS IPPS rate",13227.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5860.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5860.66,16534.81,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,CDM,100,RC,,,Inpatient,,,,,,20912.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16730.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9806.19,100,,,,,0,"case rate","100% of CMS IPPS rate",16730.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8685.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8685.44,20912.69,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,CDM,100,RC,,,Inpatient,,,,,,16706.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13365.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7062.42,100,,,,,0,"case rate","100% of CMS IPPS rate",13365.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6255.26,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6255.26,16706.64,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,CDM,100,RC,,,Inpatient,,,,,,13777.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11022.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4434.37,100,,,,,0,"case rate","100% of CMS IPPS rate",11022.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3927.56,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3927.56,13777.53,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC",760,CDM,100,RC,,,Inpatient,,,,,,16971.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13577.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6828.93,100,,,,,0,"case rate","100% of CMS IPPS rate",13577.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6048.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6048.45,16971.3,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC",761,CDM,100,RC,,,Inpatient,,,,,,12912.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10330.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4392.1,100,,,,,0,"case rate","100% of CMS IPPS rate",10330.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3890.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3890.13,12912.91,
"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C",768,CDM,100,RC,,,Inpatient,,,,,,17566.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14053.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7006.3,100,,,,,0,"case rate","100% of CMS IPPS rate",14053.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6205.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6205.55,17566.6,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES",769,CDM,100,RC,,,Inpatient,,,,,,23307.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18646.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9535.97,100,,,,,0,"case rate","100% of CMS IPPS rate",18646.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8446.11,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8446.11,23307.79,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,CDM,100,RC,,,Inpatient,,,,,,16926.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13541.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7455.28,100,,,,,0,"case rate","100% of CMS IPPS rate",13541.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6603.22,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6603.22,16926.71,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES",776,CDM,100,RC,,,Inpatient,,,,,,13694.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10955.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4943.63,100,,,,,0,"case rate","100% of CMS IPPS rate",10955.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4378.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4378.62,13694.86,
"ABORTION WITHOUT D&C",779,CDM,100,RC,,,Inpatient,,,,,,15427.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12342.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6476.95,100,,,,,0,"case rate","100% of CMS IPPS rate",12342.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5736.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5736.7,15427.83,
"CESAREAN SECTION WITH STERILIZATION WITH MCC",783,CDM,100,RC,,,Inpatient,,,,,,30415.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24332.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12763.36,100,,,,,0,"case rate","100% of CMS IPPS rate",24332.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11304.64,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11304.64,30415.09,
"CESAREAN SECTION WITH STERILIZATION WITH CC",784,CDM,100,RC,,,Inpatient,,,,,,17459.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13967.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7503.78,100,,,,,0,"case rate","100% of CMS IPPS rate",13967.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6646.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6646.18,17459.8,
"CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC",785,CDM,100,RC,,,Inpatient,,,,,,16509.75,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13207.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6052.22,100,,,,,0,"case rate","100% of CMS IPPS rate",13207.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5360.51,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5360.51,16509.75,
"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC",786,CDM,100,RC,,,Inpatient,,,,,,22933.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18346.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11196.09,100,,,,,0,"case rate","100% of CMS IPPS rate",18346.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9916.49,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9916.49,22933.54,
"CESAREAN SECTION WITHOUT STERILIZATION WITH CC",787,CDM,100,RC,,,Inpatient,,,,,,17986.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14389.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7356.89,100,,,,,0,"case rate","100% of CMS IPPS rate",14389.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6516.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6516.08,17986.38,
"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC",788,CDM,100,RC,,,Inpatient,,,,,,16519.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13215.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6268.39,100,,,,,0,"case rate","100% of CMS IPPS rate",13215.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5551.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5551.98,16519.05,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,CDM,100,RC,,,Inpatient,,,,,,24351.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19481.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12489.67,100,,,,,0,"case rate","100% of CMS IPPS rate",19481.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11062.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11062.23,24351.66,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,CDM,100,RC,,,Inpatient,,,,,,62811.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",50249.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41189.74,100,,,,,0,"case rate","100% of CMS IPPS rate",50249.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",36482.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36482.17,62811.73,
"PREMATURITY WITH MAJOR PROBLEMS",791,CDM,100,RC,,,Inpatient,,,,,,45310.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",36248.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28129.83,100,,,,,0,"case rate","100% of CMS IPPS rate",36248.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24914.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24914.88,45310.45,
"PREMATURITY WITHOUT MAJOR PROBLEMS",792,CDM,100,RC,,,Inpatient,,,,,,30360.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24288.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16973.24,100,,,,,0,"case rate","100% of CMS IPPS rate",24288.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15033.37,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15033.37,30360.33,
"FULL TERM NEONATE WITH MAJOR PROBLEMS",793,CDM,100,RC,,,Inpatient,,,,,,46337.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37070.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28896.14,100,,,,,0,"case rate","100% of CMS IPPS rate",37070.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25593.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25593.61,46337.58,
"NEONATE WITH OTHER SIGNIFICANT PROBLEMS",794,CDM,100,RC,,,Inpatient,,,,,,21321.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17057.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10228.15,100,,,,,0,"case rate","100% of CMS IPPS rate",17057.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9059.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9059.17,21321.31,
"NORMAL NEWBORN",795,CDM,100,RC,,,Inpatient,,,,,,9470.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7576.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1384.35,100,,,,,0,"case rate","100% of CMS IPPS rate",7576.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",1226.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",1226.14,9470.24,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC",796,CDM,100,RC,,,Inpatient,,,,,,18452.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14762.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7351.35,100,,,,,0,"case rate","100% of CMS IPPS rate",14762.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6511.17,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6511.17,18452.56,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC",797,CDM,100,RC,,,Inpatient,,,,,,16905.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13524.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6708.37,100,,,,,0,"case rate","100% of CMS IPPS rate",13524.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5941.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5941.67,16905.36,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC",798,CDM,100,RC,,,Inpatient,,,,,,16503.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13202.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6708.37,100,,,,,0,"case rate","100% of CMS IPPS rate",13202.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5941.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5941.67,16503.25,
"SPLENIC PROCEDURES WITH MCC",799,CDM,100,RC,,,Inpatient,,,,,,49674.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39739.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32944.58,100,,,,,0,"case rate","100% of CMS IPPS rate",39739.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29179.35,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29179.35,49674.4,
"SPLENIC PROCEDURES WITH CC",800,CDM,100,RC,,,Inpatient,,,,,,33705.46,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26964.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20188.85,100,,,,,0,"case rate","100% of CMS IPPS rate",26964.37,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",17881.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17881.47,33705.46,
"SPLENIC PROCEDURES WITHOUT CC/MCC",801,CDM,100,RC,,,Inpatient,,,,,,25342.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20274.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11374.85,100,,,,,0,"case rate","100% of CMS IPPS rate",20274.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10074.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10074.82,25342.56,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC",802,CDM,100,RC,,,Inpatient,,,,,,44614.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35691.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24838,100,,,,,0,"case rate","100% of CMS IPPS rate",35691.88,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21999.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21999.27,44614.85,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC",803,CDM,100,RC,,,Inpatient,,,,,,24878.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19902.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12333.09,100,,,,,0,"case rate","100% of CMS IPPS rate",19902.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10923.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10923.54,24878.23,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC",804,CDM,100,RC,,,Inpatient,,,,,,20207.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16166.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7660.37,100,,,,,0,"case rate","100% of CMS IPPS rate",16166.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6784.87,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6784.87,20207.81,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC",805,CDM,100,RC,,,Inpatient,,,,,,17637.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14109.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6914.84,100,,,,,0,"case rate","100% of CMS IPPS rate",14109.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6124.55,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6124.55,17637.18,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC",806,CDM,100,RC,,,Inpatient,,,,,,14617.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11693.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5013.61,100,,,,,0,"case rate","100% of CMS IPPS rate",11693.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4440.6,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4440.6,14617.06,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC",807,CDM,100,RC,,,Inpatient,,,,,,13875.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11100.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4415.66,100,,,,,0,"case rate","100% of CMS IPPS rate",11100.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3911,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3911,13875.96,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC",808,CDM,100,RC,,,Inpatient,,,,,,28119.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22495.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15868.8,100,,,,,0,"case rate","100% of CMS IPPS rate",22495.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14055.16,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14055.16,28119.36,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC",809,CDM,100,RC,,,Inpatient,,,,,,19371.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15496.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8581.19,100,,,,,0,"case rate","100% of CMS IPPS rate",15496.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7600.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7600.45,19371.05,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC",810,CDM,100,RC,,,Inpatient,,,,,,17334.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13867.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6594.74,100,,,,,0,"case rate","100% of CMS IPPS rate",13867.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5841.03,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5841.03,17334.41,
"RED BLOOD CELL DISORDERS WITH MCC",811,CDM,100,RC,,,Inpatient,,,,,,20656.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16525.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9747.99,100,,,,,0,"case rate","100% of CMS IPPS rate",16525.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8633.89,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8633.89,20656.36,
"RED BLOOD CELL DISORDERS WITHOUT MCC",812,CDM,100,RC,,,Inpatient,,,,,,16141.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12913.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6394.5,100,,,,,0,"case rate","100% of CMS IPPS rate",12913.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5663.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5663.67,16141.98,
"COAGULATION DISORDERS",813,CDM,100,RC,,,Inpatient,,,,,,21780.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17424.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10725.63,100,,,,,0,"case rate","100% of CMS IPPS rate",17424.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9499.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9499.8,21780.1,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC",814,CDM,100,RC,,,Inpatient,,,,,,27365.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21892.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14484.45,100,,,,,0,"case rate","100% of CMS IPPS rate",21892.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12829.02,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12829.02,27365.28,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC",815,CDM,100,RC,,,Inpatient,,,,,,17031.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13625.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7040.25,100,,,,,0,"case rate","100% of CMS IPPS rate",13625.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6235.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6235.62,17031.68,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC",816,CDM,100,RC,,,Inpatient,,,,,,13484.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10787.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4568.78,100,,,,,0,"case rate","100% of CMS IPPS rate",10787.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4046.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4046.62,13484.05,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC",817,CDM,100,RC,,,Inpatient,,,,,,28803.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23043.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15145.45,100,,,,,0,"case rate","100% of CMS IPPS rate",23043.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13414.47,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13414.47,28803.81,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC",818,CDM,100,RC,,,Inpatient,,,,,,18380.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14704.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6855.26,100,,,,,0,"case rate","100% of CMS IPPS rate",14704.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6071.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6071.77,18380.14,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC",819,CDM,100,RC,,,Inpatient,,,,,,15600.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12480.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4679.64,100,,,,,0,"case rate","100% of CMS IPPS rate",12480.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4144.81,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4144.81,15600.55,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC",820,CDM,100,RC,,,Inpatient,,,,,,62080.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",49664.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40340.97,100,,,,,0,"case rate","100% of CMS IPPS rate",49664.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",35730.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35730.41,62080.83,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC",821,CDM,100,RC,,,Inpatient,,,,,,28404.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22723.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15467.63,100,,,,,0,"case rate","100% of CMS IPPS rate",22723.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13699.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13699.84,28404.48,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",822,CDM,100,RC,,,Inpatient,,,,,,18796.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15036.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7924.35,100,,,,,0,"case rate","100% of CMS IPPS rate",15036.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7018.68,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7018.68,18796.19,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC",823,CDM,100,RC,,,Inpatient,,,,,,50193.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40154.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32422.85,100,,,,,0,"case rate","100% of CMS IPPS rate",40154.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",28717.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28717.25,50193.53,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC",824,CDM,100,RC,,,Inpatient,,,,,,28655.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22924.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15238.98,100,,,,,0,"case rate","100% of CMS IPPS rate",22924.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13497.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13497.32,28655.21,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC",825,CDM,100,RC,,,Inpatient,,,,,,20146.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16117.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8527.84,100,,,,,0,"case rate","100% of CMS IPPS rate",16117.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7553.2,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7553.2,20146.51,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC",826,CDM,100,RC,,,Inpatient,,,,,,51057.21,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40845.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33088.01,100,,,,,0,"case rate","100% of CMS IPPS rate",40845.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29306.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29306.38,51057.21,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC",827,CDM,100,RC,,,Inpatient,,,,,,29078.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23262.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16351.04,100,,,,,0,"case rate","100% of CMS IPPS rate",23262.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",14482.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14482.28,29078.71,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",828,CDM,100,RC,,,Inpatient,,,,,,23437.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18750.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11106.01,100,,,,,0,"case rate","100% of CMS IPPS rate",18750.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9836.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9836.71,23437.81,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC",829,CDM,100,RC,,,Inpatient,,,,,,36961.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29569.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21366.73,100,,,,,0,"case rate","100% of CMS IPPS rate",29569.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18924.73,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18924.73,36961.48,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC",830,CDM,100,RC,,,Inpatient,,,,,,21591.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17273.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10133.22,100,,,,,0,"case rate","100% of CMS IPPS rate",17273.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8975.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8975.1,21591.55,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC",831,CDM,100,RC,,,Inpatient,,,,,,18782.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15025.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7974.93,100,,,,,0,"case rate","100% of CMS IPPS rate",15025.81,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7063.48,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7063.48,18782.26,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC",832,CDM,100,RC,,,Inpatient,,,,,,14316.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11452.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5178.51,100,,,,,0,"case rate","100% of CMS IPPS rate",11452.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4586.66,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4586.66,14316.16,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC",833,CDM,100,RC,,,Inpatient,,,,,,12470.86,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9976.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3601.54,100,,,,,0,"case rate","100% of CMS IPPS rate",9976.69,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3189.92,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3189.92,12470.86,
"ACUTE LEUKEMIA WITH MCC",834,CDM,100,RC,,,Inpatient,,,,,,58599.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46879.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38297,100,,,,,0,"case rate","100% of CMS IPPS rate",46879.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",33920.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33920.05,58599.14,
"ACUTE LEUKEMIA WITH CC",835,CDM,100,RC,,,Inpatient,,,,,,26985.43,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21588.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14799.01,100,,,,,0,"case rate","100% of CMS IPPS rate",21588.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13107.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13107.63,26985.43,
"ACUTE LEUKEMIA WITHOUT CC/MCC",836,CDM,100,RC,,,Inpatient,,,,,,18940.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15152.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8608.22,100,,,,,0,"case rate","100% of CMS IPPS rate",15152.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7624.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7624.39,18940.14,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC",837,CDM,100,RC,,,Inpatient,,,,,,52232.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41785.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34693.39,100,,,,,0,"case rate","100% of CMS IPPS rate",41785.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30728.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30728.29,52232.01,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT",838,CDM,100,RC,,,Inpatient,,,,,,27000.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21600.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14052.79,100,,,,,0,"case rate","100% of CMS IPPS rate",21600.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12446.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12446.7,27000.29,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",839,CDM,100,RC,,,Inpatient,,,,,,21024.15,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16819.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9495.09,100,,,,,0,"case rate","100% of CMS IPPS rate",16819.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8409.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8409.9,21024.15,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC",840,CDM,100,RC,,,Inpatient,,,,,,37657.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30125.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22095.62,100,,,,,0,"case rate","100% of CMS IPPS rate",30125.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19570.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19570.32,37657.06,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC",841,CDM,100,RC,,,Inpatient,,,,,,22765.44,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18212.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10864.2,100,,,,,0,"case rate","100% of CMS IPPS rate",18212.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9622.53,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9622.53,22765.44,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC",842,CDM,100,RC,,,Inpatient,,,,,,16998.24,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13598.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7288.3,100,,,,,0,"case rate","100% of CMS IPPS rate",13598.59,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6455.32,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6455.32,16998.24,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC",843,CDM,100,RC,,,Inpatient,,,,,,26140.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20912.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13118.11,100,,,,,0,"case rate","100% of CMS IPPS rate",20912.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11618.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11618.84,26140.31,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC",844,CDM,100,RC,,,Inpatient,,,,,,18920.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15136.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8281.18,100,,,,,0,"case rate","100% of CMS IPPS rate",15136.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7334.73,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7334.73,18920.65,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC",845,CDM,100,RC,,,Inpatient,,,,,,15523.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12418.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5797.94,100,,,,,0,"case rate","100% of CMS IPPS rate",12418.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5135.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5135.29,15523.48,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC",846,CDM,100,RC,,,Inpatient,,,,,,31691.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25352.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17694.51,100,,,,,0,"case rate","100% of CMS IPPS rate",25352.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15672.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15672.21,31691.14,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC",847,CDM,100,RC,,,Inpatient,,,,,,19763.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15811.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8804.3,100,,,,,0,"case rate","100% of CMS IPPS rate",15811.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7798.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7798.06,19763.89,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",848,CDM,100,RC,,,Inpatient,,,,,,15503.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12402.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5673.91,100,,,,,0,"case rate","100% of CMS IPPS rate",12402.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5025.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5025.44,15503.03,
RADIOTHERAPY,849,CDM,100,RC,,,Inpatient,,,,,,32777.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26222.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18507.25,100,,,,,0,"case rate","100% of CMS IPPS rate",26222.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16392.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16392.06,32777.7,
"ACUTE LEUKEMIA WITH OTHER PROCEDURES",850,CDM,100,RC,,,Inpatient,,,,,,88035.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",70428.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",63826.49,100,,,,,0,"case rate","100% of CMS IPPS rate",70428.07,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",56531.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56531.77,88035.09,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC",853,CDM,100,RC,,,Inpatient,,,,,,53479.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42783.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34652.51,100,,,,,0,"case rate","100% of CMS IPPS rate",42783.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",30692.08,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30692.08,53479.26,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC",854,CDM,100,RC,,,Inpatient,,,,,,26170.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20936.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13844.24,100,,,,,0,"case rate","100% of CMS IPPS rate",20936.77,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12261.98,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12261.98,26170.96,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC",855,CDM,100,RC,,,Inpatient,,,,,,21519.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17215.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11263.29,100,,,,,0,"case rate","100% of CMS IPPS rate",17215.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9976.01,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9976.01,21519.13,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC",856,CDM,100,RC,,,Inpatient,,,,,,49858.26,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",39886.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31259.52,100,,,,,0,"case rate","100% of CMS IPPS rate",39886.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27686.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27686.88,49858.26,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC",857,CDM,100,RC,,,Inpatient,,,,,,27502.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22002.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15096.94,100,,,,,0,"case rate","100% of CMS IPPS rate",22002.17,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13371.52,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13371.52,27502.71,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC",858,CDM,100,RC,,,Inpatient,,,,,,20550.5,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16440.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8926.94,100,,,,,0,"case rate","100% of CMS IPPS rate",16440.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7906.68,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7906.68,20550.5,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC",862,CDM,100,RC,,,Inpatient,,,,,,24551.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19641.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12739.8,100,,,,,0,"case rate","100% of CMS IPPS rate",19641.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11283.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11283.77,24551.31,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC",863,CDM,100,RC,,,Inpatient,,,,,,16882.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13505.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6928.01,100,,,,,0,"case rate","100% of CMS IPPS rate",13505.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6136.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6136.21,16882.16,
"FEVER AND INFLAMMATORY CONDITIONS",864,CDM,100,RC,,,Inpatient,,,,,,15858.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12686.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6221.97,100,,,,,0,"case rate","100% of CMS IPPS rate",12686.97,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5510.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5510.86,15858.71,
"VIRAL ILLNESS WITH MCC",865,CDM,100,RC,,,Inpatient,,,,,,21529.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17223.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10050.08,100,,,,,0,"case rate","100% of CMS IPPS rate",17223.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8901.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8901.46,21529.35,
"VIRAL ILLNESS WITHOUT MCC",866,CDM,100,RC,,,Inpatient,,,,,,15690.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12552.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6130.51,100,,,,,0,"case rate","100% of CMS IPPS rate",12552.52,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5429.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5429.86,15690.65,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC",867,CDM,100,RC,,,Inpatient,,,,,,27054.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21643.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14857.21,100,,,,,0,"case rate","100% of CMS IPPS rate",21643.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13159.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13159.18,27054.16,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC",868,CDM,100,RC,,,Inpatient,,,,,,17190.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13752.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7275.83,100,,,,,0,"case rate","100% of CMS IPPS rate",13752.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6444.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6444.27,17190.48,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC",869,CDM,100,RC,,,Inpatient,,,,,,14391.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11513.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4985.89,100,,,,,0,"case rate","100% of CMS IPPS rate",11513.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4416.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4416.06,14391.39,
"SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS",870,CDM,100,RC,,,Inpatient,,,,,,71804.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",57443.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",48199.5,100,,,,,0,"case rate","100% of CMS IPPS rate",57443.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",42690.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",42690.79,71804.28,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC",871,CDM,100,RC,,,Inpatient,,,,,,25654.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20523.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13594.8,100,,,,,0,"case rate","100% of CMS IPPS rate",20523.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12041.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12041.05,25654.6,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC",872,CDM,100,RC,,,Inpatient,,,,,,17118.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13694.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7143.49,100,,,,,0,"case rate","100% of CMS IPPS rate",13694.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6327.06,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6327.06,17118.03,
"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS",876,CDM,100,RC,,,Inpatient,,,,,,43507.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34806.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27227.02,100,,,,,0,"case rate","100% of CMS IPPS rate",34806.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24115.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24115.25,43507.84,
"ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION",880,CDM,100,RC,,,Inpatient,,,,,,16532.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13225.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6641.85,100,,,,,0,"case rate","100% of CMS IPPS rate",13225.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5882.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5882.76,16532.04,
"DEPRESSIVE NEUROSES",881,CDM,100,RC,,,Inpatient,,,,,,16352.79,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13082.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6333.52,100,,,,,0,"case rate","100% of CMS IPPS rate",13082.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5609.67,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5609.67,16352.79,
"NEUROSES EXCEPT DEPRESSIVE",882,CDM,100,RC,,,Inpatient,,,,,,17587.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14069.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6665.41,100,,,,,0,"case rate","100% of CMS IPPS rate",14069.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5903.62,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5903.62,17587.05,
"DISORDERS OF PERSONALITY AND IMPULSE CONTROL",883,CDM,100,RC,,,Inpatient,,,,,,25875.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20700.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12845.12,100,,,,,0,"case rate","100% of CMS IPPS rate",20700.51,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11377.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11377.05,25875.64,
"ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY",884,CDM,100,RC,,,Inpatient,,,,,,22556.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18045.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11572.31,100,,,,,0,"case rate","100% of CMS IPPS rate",18045.19,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10249.72,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10249.72,22556.49,
PSYCHOSES,885,CDM,100,RC,,,Inpatient,,,,,,20586.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16469.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9766.7,100,,,,,0,"case rate","100% of CMS IPPS rate",16469.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8650.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8650.46,20586.73,
"BEHAVIORAL AND DEVELOPMENTAL DISORDERS",886,CDM,100,RC,,,Inpatient,,,,,,26887.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21510.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12447.41,100,,,,,0,"case rate","100% of CMS IPPS rate",21510.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11024.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11024.8,26887.93,
"OTHER MENTAL DISORDER DIAGNOSES",887,CDM,100,RC,,,Inpatient,,,,,,17560.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14048.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8241,100,,,,,0,"case rate","100% of CMS IPPS rate",14048.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7299.13,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7299.13,17560.11,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,CDM,100,RC,,,Inpatient,,,,,,13343.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10675.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4324.2,100,,,,,0,"case rate","100% of CMS IPPS rate",10675.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3829.99,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3829.99,13343.83,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,CDM,100,RC,,,Inpatient,,,,,,20761.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16609.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9723.04,100,,,,,0,"case rate","100% of CMS IPPS rate",16609.06,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8611.8,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8611.8,20761.33,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,CDM,100,RC,,,Inpatient,,,,,,23821.36,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19057.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12338.63,100,,,,,0,"case rate","100% of CMS IPPS rate",19057.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10928.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10928.45,23821.36,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,CDM,100,RC,,,Inpatient,,,,,,15813.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12650.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6112.5,100,,,,,0,"case rate","100% of CMS IPPS rate",12650.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5413.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5413.9,15813.23,
"WOUND DEBRIDEMENTS FOR INJURIES WITH MCC",901,CDM,100,RC,,,Inpatient,,,,,,46588.33,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37270.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30697.61,100,,,,,0,"case rate","100% of CMS IPPS rate",37270.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",27189.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27189.18,46588.33,
"WOUND DEBRIDEMENTS FOR INJURIES WITH CC",902,CDM,100,RC,,,Inpatient,,,,,,25394.58,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20315.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13147.9,100,,,,,0,"case rate","100% of CMS IPPS rate",20315.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11645.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11645.23,25394.58,
"WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC",903,CDM,100,RC,,,Inpatient,,,,,,18476.73,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14781.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8446.78,100,,,,,0,"case rate","100% of CMS IPPS rate",14781.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7481.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7481.4,18476.73,
"SKIN GRAFTS FOR INJURIES WITH CC/MCC",904,CDM,100,RC,,,Inpatient,,,,,,41726.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33381.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26752.4,100,,,,,0,"case rate","100% of CMS IPPS rate",33381.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23694.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23694.88,41726.61,
"SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC",905,CDM,100,RC,,,Inpatient,,,,,,21390.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17112.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11419.88,100,,,,,0,"case rate","100% of CMS IPPS rate",17112.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10114.71,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10114.71,21390.98,
"HAND PROCEDURES FOR INJURIES",906,CDM,100,RC,,,Inpatient,,,,,,25857.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20685.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15121.89,100,,,,,0,"case rate","100% of CMS IPPS rate",20685.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13393.61,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13393.61,25857.05,
"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC",907,CDM,100,RC,,,Inpatient,,,,,,43270.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34616.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27601.86,100,,,,,0,"case rate","100% of CMS IPPS rate",34616.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",24447.25,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24447.25,43270.1,
"OTHER O.R. PROCEDURES FOR INJURIES WITH CC",908,CDM,100,RC,,,Inpatient,,,,,,26144.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20915.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13975.88,100,,,,,0,"case rate","100% of CMS IPPS rate",20915.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12378.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12378.58,26144.04,
"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC",909,CDM,100,RC,,,Inpatient,,,,,,19805.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15844.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8787.67,100,,,,,0,"case rate","100% of CMS IPPS rate",15844.54,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7783.33,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7783.33,19805.68,
"TRAUMATIC INJURY WITH MCC",913,CDM,100,RC,,,Inpatient,,,,,,22795.16,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18236.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11212.72,100,,,,,0,"case rate","100% of CMS IPPS rate",18236.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9931.22,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9931.22,22795.16,
"TRAUMATIC INJURY WITHOUT MCC",914,CDM,100,RC,,,Inpatient,,,,,,15838.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12670.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6349.46,100,,,,,0,"case rate","100% of CMS IPPS rate",12670.63,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5623.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5623.78,15838.29,
"ALLERGIC REACTIONS WITH MCC",915,CDM,100,RC,,,Inpatient,,,,,,23231.65,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18585.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12041.39,100,,,,,0,"case rate","100% of CMS IPPS rate",18585.32,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10665.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10665.18,23231.65,
"ALLERGIC REACTIONS WITHOUT MCC",916,CDM,100,RC,,,Inpatient,,,,,,13802.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11042.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4601.35,100,,,,,0,"case rate","100% of CMS IPPS rate",11042.08,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4075.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4075.46,13802.6,
"POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC",917,CDM,100,RC,,,Inpatient,,,,,,22180.35,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17744.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11360.99,100,,,,,0,"case rate","100% of CMS IPPS rate",17744.28,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10062.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10062.54,22180.35,
"POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC",918,CDM,100,RC,,,Inpatient,,,,,,15574.55,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12459.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6129.13,100,,,,,0,"case rate","100% of CMS IPPS rate",12459.64,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5428.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5428.63,15574.55,
"COMPLICATIONS OF TREATMENT WITH MCC",919,CDM,100,RC,,,Inpatient,,,,,,24617.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19693.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12635.18,100,,,,,0,"case rate","100% of CMS IPPS rate",19693.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11191.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11191.1,24617.25,
"COMPLICATIONS OF TREATMENT WITH CC",920,CDM,100,RC,,,Inpatient,,,,,,16923.01,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13538.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7038.87,100,,,,,0,"case rate","100% of CMS IPPS rate",13538.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6234.4,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6234.4,16923.01,
"COMPLICATIONS OF TREATMENT WITHOUT CC/MCC",921,CDM,100,RC,,,Inpatient,,,,,,14007.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11206.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4764.87,100,,,,,0,"case rate","100% of CMS IPPS rate",11206.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4220.29,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4220.29,14007.84,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,CDM,100,RC,,,Inpatient,,,,,,23861.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19089.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11705.35,100,,,,,0,"case rate","100% of CMS IPPS rate",19089.04,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10367.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10367.54,23861.3,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,CDM,100,RC,,,Inpatient,,,,,,17066.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13652.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7066.58,100,,,,,0,"case rate","100% of CMS IPPS rate",13652.82,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6258.94,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6258.94,17066.03,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT",927,CDM,100,RC,,,Inpatient,,,,,,205895.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",164716.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",139352.09,100,,,,,0,"case rate","100% of CMS IPPS rate",164716.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",123425.56,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",123425.56,205895.83,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC",928,CDM,100,RC,,,Inpatient,,,,,,74227.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",59381.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",46276.09,100,,,,,0,"case rate","100% of CMS IPPS rate",59381.8,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",40987.21,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40987.21,74227.25,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC",929,CDM,100,RC,,,Inpatient,,,,,,37526.14,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",30020.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22036.04,100,,,,,0,"case rate","100% of CMS IPPS rate",30020.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19517.54,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19517.54,37526.14,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT",933,CDM,100,RC,,,Inpatient,,,,,,43779.95,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",35023.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29979.79,100,,,,,0,"case rate","100% of CMS IPPS rate",35023.96,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",26553.41,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26553.41,43779.95,
"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY",934,CDM,100,RC,,,Inpatient,,,,,,28144.45,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",22515.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14867.6,100,,,,,0,"case rate","100% of CMS IPPS rate",22515.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13168.39,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13168.39,28144.45,
"NON-EXTENSIVE BURNS",935,CDM,100,RC,,,Inpatient,,,,,,26745.83,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21396.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15218.2,100,,,,,0,"case rate","100% of CMS IPPS rate",21396.66,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",13478.91,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13478.91,26745.83,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC",939,CDM,100,RC,,,Inpatient,,,,,,41312.4,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",33049.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21991.69,100,,,,,0,"case rate","100% of CMS IPPS rate",33049.92,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",19478.27,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",19478.27,41312.4,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC",940,CDM,100,RC,,,Inpatient,,,,,,29317.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23453.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14629.26,100,,,,,0,"case rate","100% of CMS IPPS rate",23453.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",12957.28,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12957.28,29317.38,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC",941,CDM,100,RC,,,Inpatient,,,,,,26445.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21156.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13540.76,100,,,,,0,"case rate","100% of CMS IPPS rate",21156.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",11993.19,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11993.19,26445.85,
"REHABILITATION WITH CC/MCC",945,CDM,100,RC,,,Inpatient,,,,,,21996.48,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17597.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10576.66,100,,,,,0,"case rate","100% of CMS IPPS rate",17597.18,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9367.86,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9367.86,21996.48,
"REHABILITATION WITHOUT CC/MCC",946,CDM,100,RC,,,Inpatient,,,,,,18264.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14611.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7735.89,100,,,,,0,"case rate","100% of CMS IPPS rate",14611.98,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6851.76,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6851.76,18264.98,
"SIGNS AND SYMPTOMS WITH MCC",947,CDM,100,RC,,,Inpatient,,,,,,19403.56,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15522.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8911.69,100,,,,,0,"case rate","100% of CMS IPPS rate",15522.85,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7893.18,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7893.18,19403.56,
"SIGNS AND SYMPTOMS WITHOUT MCC",948,CDM,100,RC,,,Inpatient,,,,,,15048.91,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12039.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5504.85,100,,,,,0,"case rate","100% of CMS IPPS rate",12039.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",4875.7,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4875.7,15048.91,
"AFTERCARE WITH CC/MCC",949,CDM,100,RC,,,Inpatient,,,,,,18663.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",14930.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7476.07,100,,,,,0,"case rate","100% of CMS IPPS rate",14930.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6621.63,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6621.63,18663.38,
"AFTERCARE WITHOUT CC/MCC",950,CDM,100,RC,,,Inpatient,,,,,,13444.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10755.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",4060.91,100,,,,,0,"case rate","100% of CMS IPPS rate",10755.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3596.79,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3596.79,13444.13,
"OTHER FACTORS INFLUENCING HEALTH STATUS",951,CDM,100,RC,,,Inpatient,,,,,,12778.25,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10222.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3928.57,100,,,,,0,"case rate","100% of CMS IPPS rate",10222.6,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",3479.58,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",3479.58,12778.25,
"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA",955,CDM,100,RC,,,Inpatient,,,,,,70126.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",56100.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",47311.24,100,,,,,0,"case rate","100% of CMS IPPS rate",56100.9,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",41904.05,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",41904.05,70126.13,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,CDM,100,RC,,,Inpatient,,,,,,42561.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",34049.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26484.26,100,,,,,0,"case rate","100% of CMS IPPS rate",34049.22,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",23457.38,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",23457.38,42561.53,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC",957,CDM,100,RC,,,Inpatient,,,,,,78380.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",62704.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51717.2,100,,,,,0,"case rate","100% of CMS IPPS rate",62704.3,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",45806.45,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",45806.45,78380.38,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC",958,CDM,100,RC,,,Inpatient,,,,,,46749,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",37399.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",28475.57,100,,,,,0,"case rate","100% of CMS IPPS rate",37399.2,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",25221.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25221.1,46749,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",959,CDM,100,RC,,,Inpatient,,,,,,34956.41,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27965.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18318.79,100,,,,,0,"case rate","100% of CMS IPPS rate",27965.13,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16225.14,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16225.14,34956.41,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC",963,CDM,100,RC,,,Inpatient,,,,,,33003.39,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",26402.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18823.2,100,,,,,0,"case rate","100% of CMS IPPS rate",26402.71,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16671.9,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16671.9,33003.39,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC",964,CDM,100,RC,,,Inpatient,,,,,,21847.89,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",17478.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10393.74,100,,,,,0,"case rate","100% of CMS IPPS rate",17478.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",9205.84,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9205.84,21847.89,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",965,CDM,100,RC,,,Inpatient,,,,,,16349.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",13079.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6323.13,100,,,,,0,"case rate","100% of CMS IPPS rate",13079.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",5600.46,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",5600.46,16349.09,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC",969,CDM,100,RC,,,Inpatient,,,,,,64462.93,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",51570.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",43819.18,100,,,,,0,"case rate","100% of CMS IPPS rate",51570.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",38811.09,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",38811.09,64462.93,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC",970,CDM,100,RC,,,Inpatient,,,,,,32108.11,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",25686.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18383.92,100,,,,,0,"case rate","100% of CMS IPPS rate",25686.49,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",16282.82,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16282.82,32108.11,
"HIV WITH MAJOR RELATED CONDITION WITH MCC",974,CDM,100,RC,,,Inpatient,,,,,,34416.84,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",27533.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",20690.48,100,,,,,0,"case rate","100% of CMS IPPS rate",27533.47,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",18325.77,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18325.77,34416.84,
"HIV WITH MAJOR RELATED CONDITION WITH CC",975,CDM,100,RC,,,Inpatient,,,,,,19641.31,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15713.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9848.45,100,,,,,0,"case rate","100% of CMS IPPS rate",15713.05,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8722.88,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8722.88,19641.31,
"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC",976,CDM,100,RC,,,Inpatient,,,,,,15998.03,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",12798.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6949.49,100,,,,,0,"case rate","100% of CMS IPPS rate",12798.42,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",6155.23,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6155.23,15998.03,
"HIV WITH OR WITHOUT OTHER RELATED CONDITION",977,CDM,100,RC,,,Inpatient,,,,,,19666.38,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15733.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",9990.49,100,,,,,0,"case rate","100% of CMS IPPS rate",15733.1,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",8848.68,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8848.68,19666.38,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",981,CDM,100,RC,,,Inpatient,,,,,,51187.23,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",40949.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",32938.35,100,,,,,0,"case rate","100% of CMS IPPS rate",40949.78,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",29173.83,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",29173.83,51187.23,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",982,CDM,100,RC,,,Inpatient,,,,,,30446.68,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24357.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",16963.54,100,,,,,0,"case rate","100% of CMS IPPS rate",24357.34,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",15024.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15024.78,30446.68,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",983,CDM,100,RC,,,Inpatient,,,,,,23532.53,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18826.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11558.46,100,,,,,0,"case rate","100% of CMS IPPS rate",18826.02,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10237.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10237.44,23532.53,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",987,CDM,100,RC,,,Inpatient,,,,,,39454.09,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",31563.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",24269.16,100,,,,,0,"case rate","100% of CMS IPPS rate",31563.27,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",21495.44,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",21495.44,39454.09,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",988,CDM,100,RC,,,Inpatient,,,,,,22878.74,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",18302.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",11889.65,100,,,,,0,"case rate","100% of CMS IPPS rate",18302.99,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",10530.78,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",10530.78,22878.74,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",989,CDM,100,RC,,,Inpatient,,,,,,18751.61,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",15001.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",8006.11,100,,,,,0,"case rate","100% of CMS IPPS rate",15001.29,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",7091.1,100,,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",7091.1,18751.61,
"PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS",998,CDM,100,RC,,,Inpatient,,,,,,7614.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,7614.7,
UNGROUPABLE,999,CDM,100,RC,,,Inpatient,,,,,,7614.7,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,,,,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,100,MS-DRG,,,,0,"case rate","100% of CMS IPPS rate",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",,,,,,,0,other,"not separately reimbursement",6091.76,7614.7,